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Avner BS. Descriptive Data on Trends Among Patients Hospitalized With Lyme Disease in Southwest Michigan, 2017-2021. Open Forum Infect Dis 2022; 10:ofac658. [PMID: 36726545 PMCID: PMC9879706 DOI: 10.1093/ofid/ofac658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
This retrospective chart review identifies hospitalizations for Lyme disease at two southwest Michigan hospital systems, 2017-2021. Lyme admissions increased sharply, while admissions for Lyme carditis and neuroborreliosis increased in parallel. Southwest Michigan is becoming an endemic area for Lyme disease.
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Affiliation(s)
- Benjamin S Avner
- Correspondence: Benjamin S. Avner, MD, PhD, Division of Infectious Diseases, WMed Health, 1000 Oakland Dr., Kalamazoo, MI 49008, USA ()
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2
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Abstract
Lyme disease is the most common vector-borne illness in North America and Europe. The etiologic agent, Borrelia burgdorferi sensu lato, is transmitted to humans by certain species of Ixodes ticks, which are found widely in temperate regions of the Northern hemisphere. Clinical features are diverse but death is rare. The risk of human infection is determined by the distribution and abundance of vector ticks, ecologic factors influencing tick infection rates, and human behaviors that promote tick bite. Rates of infection are highest among children aged 5 to 15 years and adults aged more than 50 years. In the northeastern United States where disease is most common, exposure occurs primarily in areas immediately around the home. Knowledge of disease epidemiology is important for patient management and proper diagnosis.
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Affiliation(s)
- Paul Mead
- Bacterial Diseases Branch, Division of Vector-borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), 3156 Rampart Road, Ft Collins, CO 80521, USA.
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3
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Abstract
OBJECTIVES Zoonotic infections are difficult to recognize in children. The age distributions and seasonal occurrences of these infections vary substantially, even among those transmitted by the same vectors, and their epidemiology may change over time. The aim was to report the incidences and trends of Borrelia burgdorferi, Puumala virus, Francisella tularensis and tick-borne encephalitis (TBE) virus infections in the pediatric population (age 0-19) of Finland. METHODS A nationwide survey based on the National Infectious Disease Register was conducted from 1996 to 2019 and all laboratory-confirmed cases were included. Age-stratified incidences per 100,000 person-years were calculated. RESULTS Cumulative incidences were B. burgdorferi 11.2, TBE 0.4, Puumala virus 6.4 and F. tularensis 2.5 per 100,000 person-years. An increasing trend in the incidences of B. burgdorferi and TBE was observed. Borrelia expanded geographically northward and inland. Tularemia follows a 2-4-year epidemic cycle and rates are similar across age groups. Puumala incidences are highest in the older children. DISCUSSION Borrelia infections increased most rapidly in children 5-9 years of age and overall expanded geographically in Finland. Tularemia epidemic cycles were shorter than those previously reported. These results will help clinicians to identify these infections in different geographic areas and age groups in Finland.
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Affiliation(s)
- Ilari Kuitunen
- From the Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli
| | - Marjo Renko
- From the Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
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Kalmár Z, Briciu V, Coroian M, Flonta M, Rădulescu AL, Topan A, Mihalca AD, Lupșe M. Seroprevalence of antibodies against Borrelia burgdorferi sensu lato in healthy blood donors in Romania: an update. Parasit Vectors 2021; 14:596. [PMID: 34863277 PMCID: PMC8645117 DOI: 10.1186/s13071-021-05099-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Borrelia burgdorferi sensu lato (s.l.) genogroup is the causative agent responsible for Lyme borreliosis, a common tick-borne infectious disease in some temperate regions of the Northern Hemisphere. In humans, the clinical manifestations of Lyme borreliosis vary from dermatological infection to severe systemic manifestations. In Romania, data on the seroprevalence of Lyme borreliosis and associated risk factors are scarce and outdated, as the only seroprevalence study with a large dataset was published more than 20 years ago. Therefore, the aim of the present study was to evaluate the seroprevalence for Borrelia burgdorferi s.l. in healthy blood donors from six Romanian counties and identify the associated risk factors. METHODS The study was conducted among 1200 healthy blood donors aged between 18 and 65 years during November 2019 and September 2020 from six counties in the northwestern and central parts of Romania. A two-tiered testing strategy was applied. Positive and equivocal immunoenzymatic test results for IgG and IgM antibodies were further confirmed by Western blot. RESULTS Serum samples from 20% of the blood donors had positive or equivocal IgG and IgM ELISA index values. In total, 2.3% of the serum samples for IgG and 1.8% for IgM were positive by Western blot. The seroprevalence for both antibodies varied between 1.5% (Satu-Mare) and 6.5% (Bistrița-Năsăud) in the six counties investigated. The highest seroprevalence was observed in men (4.7%), in blood donors performing their professional activities outdoors (4.2%), and in those aged ≥ 56 years (8%). CONCLUSIONS These findings confirm the presence of specific IgG and IgM antibodies to B. burgdorferi s.l. among healthy blood donors from Romania. Furthermore, potential risk factors, such as gender, age, and behavior, associated with the presence of positive B. burgdorferi s.l. antibodies among healthy blood donors were identified.
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Affiliation(s)
- Zsuzsa Kalmár
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Violeta Briciu
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania. .,Hospital for Infectious Diseases, Cluj-Napoca, Romania.
| | - Mircea Coroian
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.,University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Cluj-Napoca, Romania
| | - Mirela Flonta
- Hospital for Infectious Diseases, Cluj-Napoca, Romania
| | | | - Adriana Topan
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Andrei Daniel Mihalca
- University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Cluj-Napoca, Romania
| | - Mihaela Lupșe
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.,Hospital for Infectious Diseases, Cluj-Napoca, Romania
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Boyer PH, Baldinger L, Degeilh B, Wirth X, Kamdem CM, Hansmann Y, Zilliox L, Boulanger N, Jaulhac B. The emerging tick-borne pathogen Neoehrlichia mikurensis: first French case series and vector epidemiology. Emerg Microbes Infect 2021; 10:1731-1738. [PMID: 34432610 PMCID: PMC8425734 DOI: 10.1080/22221751.2021.1973347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/22/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022]
Abstract
Neoehrlichia mikurensis is an intracellular bacterium transmitted in Europe and Asia by ticks of the Ixodes ricinus complex. Interest in this bacterium has increased since it was demonstrated to be responsible for febrile syndromes in patients. To date, most clinical cases have been reported in northern Europe, but case series have also been described in central Europe and China. Notably, thrombotic events occurred during the course of the disease. We investigated the presence of N. mikurensis in 10,885 I. ricinus nymphs in two regions of France (Alsace and Brittany) collected between 2013 and 2020 and in 934 patients suspected of human granulocytic anaplasmosis in Alsace, an endemic area for Lyme borreliosis, using a specific PCR assay. N. mikurensis was detected in 5.42% of the ticks from Alsace, whereas only one (0.03%) tick was found to be positive in Brittany. Spatiotemporal disparities were also noticed within the Alsace region over the four collection sites investigated, and a significant increase in the prevalence of nymphs carrying N. mikurensis was also observed in the last three years of collection. Four out of 934 screened patients were found to be positive for N. mikurensis. Two had malignancies, and the other two were apparently immunocompetent. Superficial thrombosis was noticed in one patient, and long-lasting bacteremia was noted in another patient. These four patients are the first clinical cases of neoehrlichiosis described in France. We suggest including N. mikurensis in the differential diagnosis of post-tick bite febrile syndromes to treat patients and prevent the occurrence of thrombotic complications.
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Affiliation(s)
- Pierre H. Boyer
- Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Lisa Baldinger
- French National Reference Center for Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Brigitte Degeilh
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Rennes, Rennes Cedex 9, France
- Laboratoire de Parasitologie Médicale Faculté de Médecine, Université de Rennes1., Rennes cedex, France
| | - Xavier Wirth
- Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Chasy Mewa Kamdem
- Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Yves Hansmann
- Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
- Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France
| | - Laurence Zilliox
- French National Reference Center for Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nathalie Boulanger
- Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France
- French National Reference Center for Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France
| | - Benoît Jaulhac
- Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg, France
- French National Reference Center for Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France
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6
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van Gorkom T, van Arkel GHJ, Heron M, Voet W, Thijsen SFT, Kremer K. The Usefulness of Two CXCL13 Assays on Cerebrospinal Fluid for the Diagnosis of Lyme Neuroborreliosis: a Retrospective Study in a Routine Clinical Setting. J Clin Microbiol 2021; 59:e0025521. [PMID: 34132584 DOI: 10.1128/JCM.00255-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recent studies have shown elevated levels of the B-cell chemokine (C-X-C motif) ligand 13 (CXCL13) in the cerebrospinal fluid (CSF) of patients with early Lyme neuroborreliosis (LNB). In this retrospective study, we evaluated the diagnostic performance of the Quantikine CXCL13 enzyme-linked immunosorbent assay (ELISA) (R&D Systems, Inc., MN, USA) and the recomBead CXCL13 assay (Mikrogen, Neuried, Germany) for the detection of CXCL13 in CSF. All consecutive patients from whom a CSF and a serum sample had been collected between August 2013 and June 2016 were eligible for inclusion. Patients suspected of LNB were classified as definite, possible, or non-LNB according to the guidelines of the European Federation of Neurological Societies (EFNS). Due to the limited number of LNB patients in the predefined study period, additional LNB patients were included from outside this period. In total, 156 patients (150 consecutive patients and 6 additional LNB patients) were included. Seven (4.5%) were classified as definite, eight (5.1%) as possible, and 141 (90.4%) as non-LNB patients. Receiver operating characteristic (ROC) curve analysis comparing definite-LNB patients with non-LNB patients showed a cutoff value of 85.9 pg/ml for the Quantikine CXCL13 ELISA and 252.2 pg/ml for the recomBead CXCL13 assay. The corresponding sensitivity was 100% (95% confidence interval [CI], 100% to 100%) for both, and the corresponding specificities were 98.6% (95% CI, 96.5% to 100%) for the CXCL13 ELISA and 97.2% (95% CI, 93.6% to 100%) for the recomBead CXCL13 assay. This study showed that CXCL13 in CSF can be of additional value for the diagnosis of LNB.
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Abstract
Lyme neuroborreliosis (LNB) is an infectious disease, developing after a tick bite and the dissemination of Borrelia burgdorferi sensu lato spirochetes reach the nervous system. The infection occurs in children and adults but with different clinical courses. Adults complain of radicular pain and paresis, while among the pediatric population, the most common manifestations of LNB are facial nerve palsy and/or subacute meningitis. Moreover, atypical symptoms, such as fatigue, loss of appetite, or mood changes, may also occur. The awareness of the various clinical features existence presented by children with LNB suspicion remains to be of the greatest importance to diagnose and manage the disease.
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Abstract
Objectives: Lyme borreliosis is the most common zoonotic disease in Europe and causes an estimated total burden of 10.55 disability-adjusted life years (DALY) per 100 000 population. Its incidence in Western Europe is assumed to be increasing, yet this remains to be confirmed. The aim of this study was to assess the emergence of Lyme disease in Western Europe by performing a systematic review of the scientific literature.Methods: Pubmed, Embase and grey literature were searched from database inception until August 2018 for articles reporting the incidence of Lyme borreliosis in Western European countries. We included observational studies in English that reported data on a random sample of the population and fulfilled our definition of Lyme disease diagnosis. Annual population-weighted averages and the evolution of Lyme borreliosis incidence were extracted or calculated for every Western European country.Results: Our review identified 1514 and included 18 studies next to seven surveillance reports reporting data from 16 Western European countries. Incidence of Lyme borreliosis ranged from 0.001 (Italy) to 632 (Sweden, Blekinge county) cases/100 000/year. Iceland reported the strongest emergence with an average yearly increase of 21.15% over a 12-year period, whereas Italy reported the strongest average yearly decrease of 52.71% over a 5-year period. Very limited high-quality data were available on Lyme borreliosis incidence in the southern Western European countries.Conclusion: Diagnosis of Lyme borreliosis is on the rise in some Western European countries, mostly in the northern and central part. Better surveillance in the southern countries is necessary.
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Affiliation(s)
| | - Emmy De Buck
- Department for Evidence-Based Practice, Centre for Evidence-Based Practice, Mechelen, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
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Schwartz AM, Shankar MB, Kugeler KJ, Max RJ, Hinckley AF, Meltzer MI, Nelson CA. Epidemiology and cost of Lyme disease-related hospitalizations among patients with employer-sponsored health insurance-United States, 2005-2014. Zoonoses Public Health 2021; 67:407-415. [PMID: 32462811 DOI: 10.1111/zph.12699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 01/14/2020] [Accepted: 02/03/2020] [Indexed: 11/27/2022]
Abstract
An estimated 300,000 cases of Lyme disease occur in the United States annually. Disseminated Lyme disease may result in carditis, arthritis, facial palsy or meningitis, sometimes requiring hospitalization. We describe the epidemiology and cost of Lyme disease-related hospitalizations. We analysed 2005-2014 data from the Truven Health Analytics MarketScan Commercial Claims and Encounters Databases to identify inpatient records associated with Lyme disease based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. We estimated the annual number and median cost of Lyme disease-related hospitalizations in the United States in persons under 65 years of age. Costs were adjusted to reflect 2016 dollars. Of 20,983,165 admission records contained in the inpatient databases during the study period, 2,823 (0.01%) met inclusion criteria for Lyme disease-related hospitalizations. Over half of the identified records contained an ICD-9-CM code for meningitis (n = 614), carditis (n = 429), facial palsy (n = 400) or arthritis (n = 377). Nearly 60% of hospitalized patients were male. The median cost per Lyme disease-related hospitalization was $11,688 (range: $140-$323,613). The manifestation with the highest median cost per stay was carditis ($17,461), followed by meningitis ($15,177), arthritis ($13,012) and facial palsy ($10,491). Median cost was highest among the 15- to 19-year-old age group ($12,991). Admissions occurring in January had the highest median cost ($13,777) for all study years. Based on extrapolation to the U.S. population, we estimate that 2,196 Lyme disease-related hospitalizations in persons under 65 years of age occur annually with an estimated annual cost of $25,826,237. Lyme disease is usually treated in an outpatient setting; however, some patients with Lyme disease require hospitalization, underscoring the need for effective prevention methods to mitigate these serious cases. Information from this analysis can aid economic evaluations of interventions that prevent infection and advances in disease detection.
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Affiliation(s)
- Amy M Schwartz
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Manjunath B Shankar
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kiersten J Kugeler
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Ryan J Max
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Alison F Hinckley
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Martin I Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina A Nelson
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Beltrame A, Rodari P, Mauroner L, Zanella F, Moro L, Bertoli G, Da Re F, Russo F, Napoletano G, Silva R. Emergence of Lyme borreliosis in the province of Verona, Northern Italy: Five-years of sentinel surveillance. Ticks Tick Borne Dis 2020; 12:101628. [PMID: 33373892 DOI: 10.1016/j.ttbdis.2020.101628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/29/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
We investigated the epidemiology, clinical manifestations, laboratory data and antibiotic treatment of Lyme borreliosis in the province of Verona, Northern Italy, during the period 2015-2019. One hundred and 29 cases of Lyme borreliosis were diagnosed in a single hospital representing 27 % of all cases reported in the Veneto region in the same period. The mean annual incidence of Lyme borreliosis was 0.992/100,000 inhabitants. A peak incidence of 2/100,000 inhabitants was observed in 2018. Early localized Lyme borreliosis was the most common presentation (74 %), followed by early disseminated Lyme borreliosis (21 %). One possible early Lyme neuroborreliosis and two cranial neuropathies were diagnosed. IgM and/or IgG borrelia antibodies were positive in 90 % of the cases. This significant increase of Lyme borreliosis incidence in the province of Verona highlights the need to increase knowledge on its epidemiology and clinical manifestation among both the general population and clinicians to allow early diagnosis and treatment.
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Affiliation(s)
- Anna Beltrame
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar di Valpolicella, Italy.
| | - Paola Rodari
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar di Valpolicella, Italy.
| | - Luisa Mauroner
- Laboratory Department, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar di Valpolicella, Italy.
| | - Francesca Zanella
- Direzione Prevenzione, Sicurezza Alimentare Veterinaria, Prevenzione e Sanità Pubblica, Veneto Region, Italy.
| | - Lucia Moro
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar di Valpolicella, Italy.
| | - Giulia Bertoli
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar di Valpolicella, Italy.
| | - Filippo Da Re
- Direzione Prevenzione, Sicurezza Alimentare Veterinaria, Veneto Region, Italy.
| | - Francesca Russo
- Direzione Prevenzione, Sicurezza Alimentare Veterinaria, Veneto Region, Italy.
| | - Giuseppina Napoletano
- Direzione Prevenzione, Sicurezza Alimentare Veterinaria, Prevenzione e Sanità Pubblica, Veneto Region, Italy.
| | - Ronaldo Silva
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar di Valpolicella, Italy.
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Pacheco A, Rutler O, Valenzuela I, Feldman D, Eskin B, Allegra JR. Positive Tests for Lyme Disease and Emergency Department Visits for Bell's Palsy Patients. J Emerg Med 2020; 59:820-827. [PMID: 32978030 DOI: 10.1016/j.jemermed.2020.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Etiologies for Bell's palsy include herpes viruses and Lyme disease, with highest incidence in the colder and warmer months, respectively. In New Jersey, a Lyme-endemic area, the months with the most Lyme disease (80% of cases) are May through October ("Lyme months"). OBJECTIVE Our aim was to determine whether positive tests for Lyme disease and visits are greater in the Lyme months than the rest of the year for patients with Bell's palsy in New Jersey emergency departments (EDs). METHODS We conducted a retrospective chart review from two New Jersey suburban EDs with consecutive patients from February 1, 2013 to January 31, 2018.We identified patients having Bell's palsy using the emergency physician diagnosis. We tabulated positive Lyme tests and visits for Bell's palsy by month of year. We calculated the ratio of positive tests and visits between the Lyme months and the rest of the year along with 95% confidence intervals (CIs). RESULTS There were 442 visits for Bell's palsy, 359 (81%) of these patients were tested for Lyme disease and 57 (16%) of the tests were positive. The Lyme months had 7.1 (95% CI 3.5-14.4) times more positive tests and 1.3 (95% CI 1.1-1.4) times more Bell's palsy visits than the rest of the year. Both measures peaked in July. CONCLUSIONS In a Lyme-endemic area, positive Lyme tests and ED visits for Bell's palsy are greatest in the Lyme months, peaking in July. This finding can help guide testing and treatment for patients in the ED with Bell's palsy during various months of the year.
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Affiliation(s)
| | | | | | | | - Barnet Eskin
- Morristown Medical Center, Morristown, New Jersey
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12
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Abstract
Background In Finland, the routine surveillance of Lyme borreliosis (LB) is laboratory-based. In addition, we have well established national health care registers where countrywide data from patient visits in public health care units are collected. In our previous study based on these registers, we reported an increasing incidence of both microbiologically confirmed and clinically diagnosed LB cases in Finland during the past years. Here, we evaluated our register data, refined LB incidence estimates provided in our previous study, and evaluated treatment practices considering LB in the primary health care. Methods Three national health care registers were used. The Register for Primary Health Care Visits (Avohilmo) and the National Hospital Discharge Register (Hilmo) collect physician-recorded data from the outpatient and inpatient health care visits, respectively, whereas the National Infectious Diseases Register (NIDR) represents positive findings in LB diagnostics notified electronically by microbiological laboratories. We used a personal identification number in register-linkage to identify LB cases on an individual level in the study year 2014. In addition, antibiotic purchase data was retrieved from the Finnish Social Insurance Institution in order to evaluate the LB treatment practices in the primary health care in Finland. Results Avohilmo was found to be useful in monitoring clinically diagnosed LB (i.e. erythema migrans (EM) infections), whereas Hilmo did not add much value next to existing laboratory-based surveillance of disseminated LB. However, Hilmo gave valuable information about uncertainties related to physician-based surveillance of disseminated LB and the total annual number of EM infections in our country. Antibiotic purchases associated with the LB-related outpatient visits in the primary health care indicated a good compliance with the recommended treatment guidelines. Conclusions Avohilmo and laboratory-based NIDR together are useful in monitoring LB incidence in Finland. A good compliance was observed with the recommended treatment guidelines of clinically diagnosed LB in the primary health care. In 2018, Avohilmo was introduced in the routine surveillance of LB in Finland next to laboratory-based surveillance of disseminated LB.
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Affiliation(s)
- Eeva Feuth
- Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, FI-20521, Turku, Finland. .,Department of Internal Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, FI-20521, Turku, Finland.
| | - Mikko Virtanen
- Department of Health Security, Finnish Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland
| | - Otto Helve
- Department of Health Security, Finnish Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland
| | - Jukka Hytönen
- Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, FI-20521, Turku, Finland.,Clinical Microbiology, Turku University Hospital, Kiinamyllynkatu 10, FI-20521, Turku, Finland
| | - Jussi Sane
- Department of Health Security, Finnish Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland
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Botelho-Nevers E, Gagneux-Brunon A, Velay A, Guerbois-Galla M, Grard G, Bretagne C, Mailles A, Verhoeven PO, Pozzetto B, Gonzalo S, Fafi-Kremer S, Leparc-Goffart I, Pillet S. Tick-Borne Encephalitis in Auvergne-Rhône-Alpes Region, France, 2017-2018. Emerg Infect Dis 2020; 25:1944-1948. [PMID: 31538929 PMCID: PMC6759258 DOI: 10.3201/eid2510.181923] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Three autochthonous cases of tick-borne encephalitis (TBE) acquired in rural areas of France where Lyme borreliosis, but not TBE, is endemic highlight the emergence of TBE in new areas. For patients with neurologic involvement who have been in regions where Ixodes ticks circulate, clinicians should test for TBE virus and other tickborne viruses.
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14
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Boyer PH, Koetsveld J, Zilliox L, Sprong H, Talagrand-Reboul É, Hansmann Y, de Martino SJ, Boulanger N, Hovius JW, Jaulhac B. Assessment of Borrelia miyamotoi in febrile patients and ticks in Alsace, an endemic area for Lyme borreliosis in France. Parasit Vectors 2020; 13:199. [PMID: 32303256 PMCID: PMC7165395 DOI: 10.1186/s13071-020-04071-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/09/2020] [Indexed: 12/30/2022] Open
Abstract
Background Borrelia miyamotoi is a relapsing fever Borrelia species transmitted by ticks of the Ixodes ricinus complex. Human disease caused by B. miyamotoi was first described in Russia and later in the USA and Japan. Additionally, five cases of meningoencephalitis in immunocompromised patients and one case in an apparently immunocompetent patient were described. Methods We investigated the presence of B. miyamotoi in I. ricinus nymphs and in patients suspected of human granulocytic anaplasmosis, in Alsace (France), an endemic area for I. ricinus ticks and Lyme borreliosis, using direct (PCR) and indirect diagnosis (glycerophosphoryldiester-phosphodiesterase (GlpQ) serology). Results Borrelia miyamotoi was found in 2.2% of 4354 ticks collected between 2013 and 2016. None of the 575 blood samples, collected from the patients suspected of HGA, was found positive for B. miyamotoi by PCR. Acute and late sera from 138 of these 575 patients were available. These paired sera were tested for IgM and IgG antibodies against the B. miyamotoi GlpQ antigen. A total of 14 out of 138 patients had at least one positive parameter (i.e. anti-GlpQ IgG and/or IgM). One patient seroconverted for IgG, and three had isolated IgM in the acute serum. These three patients were treated with doxycycline which could have prevented seroconversion. After reviewing clinical data and other biological tests performed, co-exposure among different microorganisms vectored by ticks or serological cross-reactivity could not be ruled out in these different cases. One patient had persistent IgG, which strongly suggests previous exposure to B. miyamotoi. Conclusions Humans can be exposed to B. miyamotoi through tick bites in Alsace. We present serological data for possible B. miyamotoi exposure or infection of patients with fever after tick bite. Future studies should determine the incidence, clinical course and burden of this emerging tick-borne disease in other parts of Western Europe.![]()
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Affiliation(s)
- Pierre H Boyer
- University of Strasbourg, Virulence bactérienne précoce UR7290-Lyme borreliosis group, FMTS - CHRU Strasbourg, Institut de Bactériologie, Strasbourg, France
| | - Joris Koetsveld
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands
| | - Laurence Zilliox
- French National Reference Center for Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hein Sprong
- Centre for Zoonoses & Environmental Microbiology, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Émilie Talagrand-Reboul
- University of Strasbourg, Virulence bactérienne précoce UR7290-Lyme borreliosis group, FMTS - CHRU Strasbourg, Institut de Bactériologie, Strasbourg, France
| | - Yves Hansmann
- University of Strasbourg, Virulence bactérienne précoce UR7290-Lyme borreliosis group, FMTS - CHRU Strasbourg, Institut de Bactériologie, Strasbourg, France.,Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sylvie Josiane de Martino
- University of Strasbourg, Virulence bactérienne précoce UR7290-Lyme borreliosis group, FMTS - CHRU Strasbourg, Institut de Bactériologie, Strasbourg, France.,French National Reference Center for Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nathalie Boulanger
- University of Strasbourg, Virulence bactérienne précoce UR7290-Lyme borreliosis group, FMTS - CHRU Strasbourg, Institut de Bactériologie, Strasbourg, France.,French National Reference Center for Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands
| | - Benoît Jaulhac
- University of Strasbourg, Virulence bactérienne précoce UR7290-Lyme borreliosis group, FMTS - CHRU Strasbourg, Institut de Bactériologie, Strasbourg, France. .,French National Reference Center for Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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15
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Tulloch JSP, Christley RM, Radford AD, Warner JC, Beadsworth MBJ, Beeching NJ, Vivancos R. A descriptive epidemiological study of the incidence of newly diagnosed Lyme disease cases in a UK primary care cohort, 1998-2016. BMC Infect Dis 2020; 20:285. [PMID: 32299372 PMCID: PMC7164244 DOI: 10.1186/s12879-020-05018-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 04/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Primary care is likely to see the highest number of Lyme disease patients. Despite this, there is limited published data regarding Lyme disease patients accessing primary care in the UK. We aim to describe trends in the incidence of a new diagnosis, and demographics of patients identified in a primary care electronic health database. METHODS A descriptive epidemiological study of Lyme disease coded patients in UK primary care. 3725 patients coded for Lyme disease during 1998-2016 were identified within The Health Improvement Network (THIN). Incidence rates and the demographics of cases identified were described. Poisson regression was used to analyse socio-demographic characteristics of the cases. RESULTS There was an increase in annual crude incidence rates, peaking in 2015 at 5.47 (95% CI 4.85-6.14) cases per 100,000 population per year. Multivariable analysis showed there were significant differences in the ages of those affected, incidence of a new diagnosis rose as deprivation levels improved, and that there was a higher incidence of cases living in rural areas compared to urban areas. There was no significant difference between sexes for the UK. Cases were significantly more likely to identify with being white compared to the national population. CONCLUSIONS An increasing incidence of patients newly coded with Lyme disease related Read codes was identified using data from a UK national primary care database. By comparing these incidence figures with national laboratory-confirmed surveillance data, a multiplication factor of 2.35 (95%CI 1.81-2.88) can be calculated in order to estimate the annual number of cases seen in primary care. The significant socio-demographic variables associated with a Lyme disease diagnosis likely reflect a complex interplay of socio-economic issues, which needs to be further explored. Future work is needed to examine the treatment and management of patients within this database.
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Affiliation(s)
- John S P Tulloch
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK.
- Public Health England, L3 1DS, Liverpool, UK.
| | - Robert M Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Alan D Radford
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Jenny C Warner
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, SP4 0JQ, UK
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, SP4 0JQ, UK
| | - Mike B J Beadsworth
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Nick J Beeching
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Roberto Vivancos
- Public Health England, L3 1DS, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Liverpool, L3 1DS, UK
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16
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Voitey M, Bouiller K, Chirouze C, Fournier D, Bozon F, Klopfenstein T. Functional signs in patients consulting for presumed Lyme borreliosis. Med Mal Infect 2019; 50:423-427. [PMID: 31722861 DOI: 10.1016/j.medmal.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/24/2018] [Accepted: 10/16/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Little is known about the functional symptoms associated with Lyme borreliosis (LB) in Europe. We aimed to assess functional symptoms associated with presumed LB and to compare patients with and without confirmed LB. MATERIALS AND METHODS We performed a retrospective monocenter study. Patients consulting for presumed LB were included. RESULTS Between November 2015 and June 2018, 355patients were included (mean age: 51years, 52% of women) of which 48had LB: erythema migrans (42%), early disseminated LB (50%; 35% of neuroborreliosis cases), and late disseminated LB (8%). The most frequently reported functional symptoms were neuropathic pain (23%), arthralgia (23%), and asthenia (17%). Other functional symptoms were rare (≤10%). Three hundred and seven (86%) patients did not have LB. Patients with confirmed LB reported fewer functional symptoms than patients without LB (1.8 (±1.7) vs. 3.6 (±2.5), P<0.001) with a shorter duration of symptoms (< 3 months in 48% vs. 16% of cases, P<0.001). They less often reported asthenia (17% vs. 59%, P<0.001), widespread pain (10% vs. 31%, P=0.003), myalgia (10% vs. 32%, P=0.002), memory disorders (4% vs. 16%, P=0.03), irritability (2% vs. 23%, P±0.001), and sadness (0% vs. 16%, P=0.003). CONCLUSION In patients consulting for presumed LB, patients diagnosed with LB had fewer and shorter functional symptoms than patients without LB.
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Affiliation(s)
- M Voitey
- Service de maladies infectieuses et tropicales, CHRU Besançon, 25000 Besançon, France
| | - K Bouiller
- Service de maladies infectieuses et tropicales, CHRU Besançon, 25000 Besançon, France; UMR CNRS 6249 chrono-environnement, université de Bourgogne Franche-Comté, 25000 Besançon, France.
| | - C Chirouze
- Service de maladies infectieuses et tropicales, CHRU Besançon, 25000 Besançon, France; UMR CNRS 6249 chrono-environnement, université de Bourgogne Franche-Comté, 25000 Besançon, France
| | - D Fournier
- Laboratoire de bactériologie, CHRU Besançon, 25000 Besançon, France
| | - F Bozon
- Service de maladies infectieuses et tropicales, CHRU Besançon, 25000 Besançon, France
| | - T Klopfenstein
- Service de maladies infectieuses et tropicales, CHRU Besançon, 25000 Besançon, France
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17
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Grech-Angelini S, Stachurski F, Vayssier-Taussat M, Devillers E, Casabianca F, Lancelot R, Uilenberg G, Moutailler S. Tick-borne pathogens in ticks (Acari: Ixodidae) collected from various domestic and wild hosts in Corsica (France), a Mediterranean island environment. Transbound Emerg Dis 2019; 67:745-757. [PMID: 31630482 DOI: 10.1111/tbed.13393] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/02/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023]
Abstract
Corsica is a mountainous French island in the north-west of the Mediterranean Sea presenting a large diversity of natural environments where many interactions between humans, domestic animals and wild fauna occur. Despite this favourable context, tick-borne pathogens (TBPs) have not systematically been investigated. In this study, a large number of TBPs were screened in ticks collected over a period of one year from domestic and wild hosts in Corsica. More than 1,500 ticks belonging to nine species and five genera (Rhipicephalus, Hyalomma, Dermacentor, Ixodes and Haemaphysalis) were analysed individually or pooled (by species, gender, host and locality). A real-time microfluidic PCR was used for high-throughput screening of TBP DNA. This advanced methodology enabled the simultaneous detection of 29 bacterial and 12 parasitic species (including Borrelia, Anaplasma, Ehrlichia, Rickettsia, Bartonella, Candidatus Neoehrlichia, Coxiella, Francisella, Babesia and Theileria). The Crimean-Congo haemorrhagic fever (CCHF) virus was investigated individually in tick species known to be vectors or carriers of this virus. In almost half of the tick pools (48%), DNA from at least one pathogen was detected and eleven species of TBPs from six genera were reported. TBPs were found in ticks from all collected hosts and were present in more than 80% of the investigated area. The detection of DNA of certain species confirmed the previous identification of these pathogens in Corsica, such as Rickettsia aeschlimannii (23% of pools), Rickettsia slovaca (5%), Anaplasma marginale (4%) and Theileria equi (0.4%), but most TBP DNA identified had not previously been reported in Corsican ticks. This included Anaplasma phagocytophilum (16%), Rickettsia helvetica (1%), Borrelia afzelii (0.7%), Borrelia miyamotoi (1%), Bartonella henselae (2%), Babesia bigemina (2%) and Babesia ovis (0.5%). The high tick infection rate and the diversity of TBPs reported in this study highlight the probable role of animals as reservoir hosts of zoonotic pathogens and human exposure to TBPs in Corsica.
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Affiliation(s)
| | - Frédéric Stachurski
- CIRAD, UMR ASTRE, Montpellier, France.,ASTRE, CIRAD, INRA, Univ. Montpellier, Montpellier, France
| | - Muriel Vayssier-Taussat
- UMR BIPAR, Animal Health Laboratory, ANSES, INRA, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
| | - Elodie Devillers
- UMR BIPAR, Animal Health Laboratory, ANSES, INRA, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
| | - François Casabianca
- INRA, UR045 Laboratoire de Recherches sur le Développement de l'élevage, Corte, France
| | - Renaud Lancelot
- CIRAD, UMR ASTRE, Montpellier, France.,ASTRE, CIRAD, INRA, Univ. Montpellier, Montpellier, France
| | | | - Sara Moutailler
- UMR BIPAR, Animal Health Laboratory, ANSES, INRA, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
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18
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Tulloch JSP, Decraene V, Christley RM, Radford AD, Warner JC, Vivancos R. Characteristics and patient pathways of Lyme disease patients: a retrospective analysis of hospital episode data in England and Wales (1998-2015). BMC Public Health 2019; 19:931. [PMID: 31412819 PMCID: PMC6694565 DOI: 10.1186/s12889-019-7245-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
Background Lyme disease is a tick-borne disease of increasing global importance. There is scant information on Lyme disease patient demographics in England and Wales, and how they interact with the National Health Service (NHS). Our aims were to explore the demographic characteristics of Lyme disease patients within the Hospital Episode Statistics (HES) and Patient Episode Database for Wales (PEDW), and to describe patient pathways. Methods Data from 1st January 1998 to 31st December 2015 was retrieved from the two administrative hospital datasets (HES and PEDW), based on patients coded with Lyme disease. Information was collected on demographic characteristics, home address and case management. Incidence rates were calculated, and demographics compared to the national population. Results Within HES and PEDW, 2361 patients were coded with Lyme disease. There was a significant increase (p < 0.01) in incidence from 0.08 cases/100,000 in 1998, to 0.53 cases/100,000 in 2015. There was a bimodal age distribution, patients were predominantly female, white and from areas of low deprivation. New cases peaked annually in August, with higher incidence rates in southern central and western England. Within hospital admission data (n = 2066), most cases were either referred from primary care (28.8%, n = 596) or admitted via accident and emergency (A&E) (29.5%, n = 610). This population entering secondary care through A&E suggest a poor understanding of the recommended care pathways for symptoms related to Lyme disease by the general population. Conclusions These data can be used to inform future investigations into Lyme disease burden, and patient management within the NHS. They provide demographic information for clinicians to target public health messaging or interventions.
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Affiliation(s)
- John S P Tulloch
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK. .,Public Health England, Liverpool, L3 1DS, UK.
| | | | - Rob M Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Alan D Radford
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Jenny C Warner
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, SP4 0JQ, UK.,Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, SP4 0JQ, UK
| | - Roberto Vivancos
- Public Health England, Liverpool, L3 1DS, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Liverpool, L3 1DS, UK
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19
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Figoni J, Chirouze C, Hansmann Y, Lemogne C, Hentgen V, Saunier A, Bouiller K, Gehanno J, Rabaud C, Perrot S, Caumes E, Eldin C, de Broucker T, Jaulhac B, Roblot F, Toubiana J, Sellal F, Vuillemet F, Sordet C, Fantin B, Lina G, Gocko X, Dieudonné M, Picone O, Bodaghi B, Gangneux J, Degeilh B, Partouche H, Lenormand C, Sotto A, Raffetin A, Monsuez J, Michel C, Boulanger N, Cathebras P, Tattevin P. Lyme borreliosis and other tick-borne diseases. Guidelines from the French Scientific Societies (I): prevention, epidemiology, diagnosis. Med Mal Infect 2019; 49:318-34. [DOI: 10.1016/j.medmal.2019.04.381] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022]
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20
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Tulloch JSP, Semper AE, Brooks TJG, Russell K, Halsby KD, Christley RM, Radford AD, Vivancos R, Warner JC. The demographics and geographic distribution of laboratory-confirmed Lyme disease cases in England and Wales (2013-2016): an ecological study. BMJ Open 2019; 9:e028064. [PMID: 31362976 PMCID: PMC6677960 DOI: 10.1136/bmjopen-2018-028064] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Lyme disease is a tick-borne disease of increasing incidence and public concern across the Northern Hemisphere. However, the socio-demographics and geographic distribution of the population affected in England and Wales are poorly understood. Therefore, the proposed study was designed to describe the demographics and distribution of laboratory-confirmed cases of Lyme disease from a national testing laboratory. DESIGN An ecological study of routinely collected laboratory surveillance data. SETTING Public Health England's national Lyme disease testing laboratory. PARTICIPANTS 3986 laboratory-confirmed cases of Lyme disease between 2013 and 2016. RESULTS In England and Wales, the incidence of laboratory-confirmed Lyme disease rose significantly over the study period from 1.62 cases per 100 000 in 2013 to 1.95 cases per 100 000 in 2016. There was a bimodal age distribution (with peaks at 6-10 and 61-65 years age bands) with a predominance of male patients. A significant clustering of areas with high Lyme disease incidence was located in southern England. An association was found between disease incidence and socioeconomic status, based on the patient's resident postcode, with more cases found in less deprived areas. Cases were disproportionately found in rural areas compared with the national population distribution. CONCLUSIONS These results suggest that Lyme disease patients originate from areas with higher socioeconomic status and disproportionately in rural areas. Identification of the Lyme disease hotspots in southern England, alongside the socio-demographics described, will enable a targeted approach to public health interventions and messages.
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Affiliation(s)
- John S P Tulloch
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Field Epidemiology Service, Public Health England, Liverpool, UK
| | - Amanda E Semper
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, UK
| | - Tim J G Brooks
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, UK
| | | | - Kate D Halsby
- National Infection Service, Public Health England, London, UK
| | - Robert M Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Neston, UK
| | - Alan D Radford
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Neston, UK
| | - Roberto Vivancos
- Field Epidemiology Service, Public Health England, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Liverpool, UK
| | - Jenny C Warner
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, UK
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21
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Zanzani SA, Rimoldi SG, Manfredi M, Grande R, Gazzonis AL, Merli S, Olivieri E, Giacomet V, Antinori S, Cislaghi G, Bestetti G, Nan K, Sala V, Gismondo MR, Atzori C, De Faveri E. Lyme borreliosis incidence in Lombardy, Italy (2000-2015): Spatiotemporal analysis and environmental risk factors. Ticks Tick Borne Dis 2019; 10:101257. [PMID: 31285164 DOI: 10.1016/j.ttbdis.2019.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 11/16/2022]
Abstract
Lyme borreliosis cases have been reported from Lombardy in northern Italy, where Ixodes ricinus is the main vector of Borrelia burgdorferi sensu lato. However, spatial and temporal variation in the incidence of Lyme borreliosis is not well understood. In the present study, based on new notified cases of Lyme borreliosis from 2000 to 2015, an average of 1.24 new cases per million residents per year was documented. New cases, georeferenced at the municipal level, were analyzed by retrospective space-time analysis (using SaTScan v. 9.3.1); and land cover, extrapolated from a Corine Land Cover dataset (using QGIS 2.8.1), was used to implement an environmental risk factor analysis. Firstly, a temporal high-risk cluster was detected in Lombardy: the relative risk of Lyme borreliosis was 3.73 times higher during 2008-2015 compared with the entire study period. Moreover, in a spatiotemporal high-risk cluster with a circular base, land cover consisting of wildland-urban interface, meadow, forest and meadow-forest transition were significantly higher compared to low-risk areas. Results of the present study demonstrate that the incidence of Lyme borreliosis is increasing in Lombardy and that environmental conditions are suitable for I. ricinus ticks infected with B. burgdorferi s.l.: citizens and health systems should be aware of Lyme borreliosis to reduce tick bites with personal protective behaviors and to avoid misdiagnosis, particularly within the area including the observed high-risk cluster. Economic resources should be invested to inform about methods to prevent tick bites, how to check people and pets after frequenting risk areas, and ways of removing the biting ticks when they are found.
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Affiliation(s)
- Sergio A Zanzani
- Department of Veterinary Medicine, Università degli Studi di Milano, 20133, Milano, Italy.
| | - Sara G Rimoldi
- Diagnostic Services, Clinical Microbiology, Virology and Bioemergence Diagnostics, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, 20157, Milano, Italy.
| | - MariaTeresa Manfredi
- Department of Veterinary Medicine, Università degli Studi di Milano, 20133, Milano, Italy.
| | - Romualdo Grande
- Diagnostic Services, Clinical Microbiology, Virology and Bioemergence Diagnostics, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, 20157, Milano, Italy.
| | - Alessia L Gazzonis
- Department of Veterinary Medicine, Università degli Studi di Milano, 20133, Milano, Italy.
| | - Stefania Merli
- I Division of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, 20157, Milan, Italy.
| | - Emanuela Olivieri
- Department of Biology and Biotechnology "L. Spallanzani", Università degli Studi di Pavia, 27100, Pavia, Italy.
| | - Vania Giacomet
- Unit of Pediatrics Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, 20157, Milano, Italy.
| | - Spinello Antinori
- III Division of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, 20157, Milano, Italy.
| | - Giuliana Cislaghi
- Unit of Neurology, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, 20157, Milano, Italy.
| | - Giovanna Bestetti
- III Division of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, 20157, Milano, Italy.
| | - Katiuscia Nan
- Unit of Dermatology and Venearology Ospedale Maggiore di Trieste, 34125, Trieste, Italy.
| | - Vittorio Sala
- Department of Veterinary Medicine, Università degli Studi di Milano, 20133, Milano, Italy.
| | - Maria R Gismondo
- Diagnostic Services, Clinical Microbiology, Virology and Bioemergence Diagnostics, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, 20157, Milano, Italy.
| | - Chiara Atzori
- I Division of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, 20157, Milan, Italy.
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22
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Akl T, Bourgoin G, Souq ML, Appolinaire J, Poirel MT, Gibert P, Abi Rizk G, Garel M, Zenner L. Detection of tick-borne pathogens in questing Ixodes ricinus in the French Pyrenees and first identification of Rickettsia monacensis in France. ACTA ACUST UNITED AC 2019; 26:20. [PMID: 30943150 PMCID: PMC6447091 DOI: 10.1051/parasite/2019019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/15/2019] [Indexed: 01/08/2023]
Abstract
Ticks are important vectors of several human and animal pathogens. In this study, we estimated the prevalence of important tick-borne infections in questing ticks from an area in Southwestern France (Hautes-Pyrénées) inhabited by Pyrenean chamois (Rupicapra pyrenaica pyrenaica) experiencing high tick burden. We examined adult and nymph ticks collected by the flag dragging method from 8 to 15 sites in the Pic de Bazès during the years 2009, 2011, 2013 and 2015. PCR assays were conducted on selected ticks for the detection of Borrelia burgdorferi s.l., Babesia spp., Rickettsia spp., spotted fever group (SFG) Rickettsia and Anaplasma phagocytophilum. Randomly selected positive samples were submitted for sequence analysis. A total of 1971 questing ticks were collected including 95 males, 101 females and 1775 nymphs. All collected ticks were identified as Ixodes ricinus. Among them, 696 ticks were selected for pathogen detection and overall prevalence was 8.4% for B. burgdorferi s.l.; 0.4% for Babesia spp.; 6.1% for A. phagocytophilum; 17.6% for Rickettsia spp.; and 8.1% for SFG Rickettsia. Among the sequenced pathogens, we detected in this population of ticks the presence of Babesia sp. EU1 and Rickettsia helvetica, as well as Rickettsia monacensis for the first time in France. The detection of these pathogens in the Pic de Bazès highlights the potential infection risks for visitors to this area and the Pyrenean chamois population.
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Affiliation(s)
- Toufic Akl
- Université Libanaise, Faculté d'Agronomie et de Médecine Vétérinaire, Département de Médecine Vétérinaire, 6573 Beyrouth, Liban
| | - Gilles Bourgoin
- Université de Lyon, VetAgro Sup - Campus Vétérinaire de Lyon, Laboratoire de Parasitologie Vétérinaire, 1 avenue Bourgelat, BP 83, 69280 Marcy l'Etoile, France - Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, 69622 Villeurbanne, France
| | - Marie-Line Souq
- Université de Lyon, VetAgro Sup - Campus Vétérinaire de Lyon, Laboratoire de Parasitologie Vétérinaire, 1 avenue Bourgelat, BP 83, 69280 Marcy l'Etoile, France
| | - Joël Appolinaire
- Office National de la Chasse et de la Faune Sauvage, Unité Ongulés Sauvages, 5 allée de Bethléem, 9 Z.I. Mayencin, 38610 Gières, France
| | - Marie-Thérèse Poirel
- Université de Lyon, VetAgro Sup - Campus Vétérinaire de Lyon, Laboratoire de Parasitologie Vétérinaire, 1 avenue Bourgelat, BP 83, 69280 Marcy l'Etoile, France - Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, 69622 Villeurbanne, France
| | - Philippe Gibert
- Office National de la Chasse et de la Faune Sauvage, Unité Ongulés Sauvages, 5 allée de Bethléem, 9 Z.I. Mayencin, 38610 Gières, France
| | - Georges Abi Rizk
- Université Libanaise, Faculté d'Agronomie et de Médecine Vétérinaire, Département de Médecine Vétérinaire, 6573 Beyrouth, Liban
| | - Mathieu Garel
- Office National de la Chasse et de la Faune Sauvage, Unité Ongulés Sauvages, 5 allée de Bethléem, 9 Z.I. Mayencin, 38610 Gières, France
| | - Lionel Zenner
- Université de Lyon, VetAgro Sup - Campus Vétérinaire de Lyon, Laboratoire de Parasitologie Vétérinaire, 1 avenue Bourgelat, BP 83, 69280 Marcy l'Etoile, France - Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, 69622 Villeurbanne, France
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Guet-revillet H, Levy C, Vallet C, Maghraoui-slim V, Dommergues M, Hentgen V, Paget C, Laugel V, Cohen R, Ferroni A. Lyme neuroborreliosis in children: Report of nine cases and a review of the literature. Arch Pediatr 2019; 26:133-7. [DOI: 10.1016/j.arcped.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/07/2019] [Accepted: 02/09/2019] [Indexed: 11/19/2022]
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Septfons A, Goronflot T, Jaulhac B, Roussel V, De Martino S, Guerreiro S, Launay T, Fournier L, De Valk H, Figoni J, Blanchon T, Couturier E. Epidemiology of Lyme borreliosis through two surveillance systems: the national Sentinelles GP network and the national hospital discharge database, France, 2005 to 2016. Euro Surveill 2019; 24:1800134. [PMID: 30892181 PMCID: PMC6425552 DOI: 10.2807/1560-7917.es.2019.24.11.1800134] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Lyme borreliosis (LB) is the most frequent vector-borne disease in France. Since 2009, surveillance of LB is conducted by a sentinel network of general practitioners (GPs). This system, in conjunction with the national hospitalisation database was used to estimate the incidence and describe the characteristics of LB in France. AIM To describe the estimated incidence and trends in GP consultations and hospital admissions for LB in France and identify risk groups and high-incidence regions. RESULTS From 2011 to 2016, the mean yearly incidence rate of LB cases was 53 per 100,000 inhabitants (95% CI: 41-65) ranging from 41 in 2011 to 84 per 100 000 in 2016. A mean of 799 cases per year were hospitalised with LB associated diagnoses 2005-16. The hospitalisation incidence rate (HIR) ranged from 1.1 cases per 100,000 inhabitants in 2005 to 1.5 in 2011 with no statistically significant trend. We observed seasonality with a peak during the summer, important inter-regional variations and a bimodal age distribution in LB incidence and HIR with higher incidence between 5 and 9 year olds and those aged 60 years. Erythema migrans affected 633/667 (95%) of the patients at primary care level. Among hospitalised cases, the most common manifestation was neuroborreliosis 4,906/9,594 (51%). CONCLUSION Public health strategies should focus on high-incidence age groups and regions during the months with the highest incidences and should emphasise prevention measures such as regular tick checks after exposure and prompt removal to avoid infection.
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Affiliation(s)
- A Septfons
- Santé publique France, Paris, France,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - T Goronflot
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - B Jaulhac
- Early Bacterial Virulence: Lyme borreliosis Group, Université de Strasbourg, CHRU Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, VBP EA 7290, Strasbourg, France,Centre National de Référence des Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - V Roussel
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - S De Martino
- Early Bacterial Virulence: Lyme borreliosis Group, Université de Strasbourg, CHRU Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, VBP EA 7290, Strasbourg, France,Centre National de Référence des Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - S Guerreiro
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - T Launay
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - L Fournier
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - H De Valk
- Santé publique France, Paris, France
| | - J Figoni
- Santé publique France, Paris, France
| | - T Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
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Cicculli V, Capai L, Quilichini Y, Masse S, Fernández-Alvarez A, Minodier L, Bompard P, Charrel R, Falchi A. Molecular investigation of tick-borne pathogens in ixodid ticks infesting domestic animals (cattle and sheep) and small rodents (black rats) of Corsica, France. Ticks Tick Borne Dis 2019; 10:606-613. [PMID: 30777731 DOI: 10.1016/j.ttbdis.2019.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/09/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
Although livestock farming (sheep, goats, pigs, and cattle) is an important economic activity in Corsica, a French Mediterranean island, knowledge about the tick fauna and microorganisms carried by them remains scarce. This study aimed to investigate the presence and perform molecular characterization of Anaplasmataceae, Rickettsia spp., and Borrelia burgdorferi sensu lato (sl) in tick species collected in Corsica. Ticks from cattle (Bos taurus), sheep (Ovis aries), and rodents (Rattus rattus) were collected from May to September 2016. DNA was purified from ticks, submitted to quantitative real-time polymerase chain reaction (qPCR) and sequenced for phylogenetic analysis. In total, 660 ticks were collected from 111 animals during the study. The most abundant collected tick species from cattle was Rhipicephalus bursa (n = 495; 84.5%), followed by Hyalomma marginatum (n = 91; 15.5%). Rhipicephalus bursa and Ixodes ricinus were the only tick species collected from sheep and rodents, respectively. Overall, Rickettsia was the most common pathogen group (n = 48; 24%) detected in ticks. Sequence analysis of partial gltA and ompA genes revealed the presence of Ri. aeschlimannii and Candidatus Ri. barbariae. Anaplasmataceae DNA was detected in eight (6%) of the 127 cattle pools and in one (2%) of the 61 R. bursa specimens collected from sheep. Sequence analysis of the rpoB gene revealed the presence of one Anaplasma species, A. marginale. Borrelia burgdorferi sl DNA was detected in one pool of H. marginatum collected from cattle and in two (15%) of the 13 I. ricinus pools collected from nine black rats. To our knowledge, this is the first report of the occurrence and molecular characterization of Candidatus Ri. barbariae, an emerging member of the Rickettsia group causing spotted fever, in Corsica. The detection of B. burgdorferi sl DNA, which was previously believed to be rare in Corsica, confirms the presence of this agent on the island.
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Affiliation(s)
- V Cicculli
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France.
| | - L Capai
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France.
| | - Y Quilichini
- CNRS - Università di Corsica, UMR 6134 - SPE, Corte, France.
| | - S Masse
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France.
| | | | - L Minodier
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France.
| | - P Bompard
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 56, Boulevard Vincent Auriol, 81393-75646, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP UMRS 1136), Paris, France.
| | - R Charrel
- UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille Univ - IRD 190 - Inserm 1207 - EHESP - IHU Méditerranée Infection), Marseille, France
| | - A Falchi
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France.
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Garcia-Marti I, Zurita-Milla R, Harms MG, Swart A. Using volunteered observations to map human exposure to ticks. Sci Rep 2018; 8:15435. [PMID: 30337654 PMCID: PMC6194133 DOI: 10.1038/s41598-018-33900-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/04/2018] [Indexed: 01/01/2023] Open
Abstract
Lyme borreliosis (LB) is the most prevalent tick-borne disease in Europe and its incidence has steadily increased over the last two decades. In the Netherlands alone, more than 20,000 citizens are affected by LB each year. Because of this, two Dutch citizen science projects were started to monitor tick bites. Both projects have collected nearly 50,000 geo-located tick bite reports over the period 2006–2016. The number of tick bite reports per area unit is a proxy of tick bite risk. This risk can also be modelled as the result of the interaction of hazard (e.g. tick activity) and human exposure (e.g. outdoor recreational activities). Multiple studies have focused on quantifying tick hazard. However, quantifying human exposure is a harder task. In this work, we make a first step to map human exposure to ticks by combining tick bite reports with a tick hazard model. Our results show human exposure to tick bites in all forested areas of the Netherlands. This information could facilitate the cooperation between public health specialists and forest managers to create better mitigation campaigns for tick-borne diseases, and it could also support the design of improved plans for ecosystem management.
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Affiliation(s)
- Irene Garcia-Marti
- Department of Geo-Information Processing, Faculty of Geo-Information and Earth Observation (ITC), University of Twente, Enschede, The Netherlands.
| | - Raul Zurita-Milla
- Department of Geo-Information Processing, Faculty of Geo-Information and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
| | - Margriet G Harms
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arno Swart
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Enkelmann J, Böhmer M, Fingerle V, Siffczyk C, Werber D, Littmann M, Merbecks SS, Helmeke C, Schroeder S, Hell S, Schlotthauer U, Burckhardt F, Stark K, Schielke A, Wilking H. Incidence of notified Lyme borreliosis in Germany, 2013-2017. Sci Rep 2018; 8:14976. [PMID: 30297731 PMCID: PMC6175818 DOI: 10.1038/s41598-018-33136-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
Lyme borreliosis (LB) is the most commonly reported tick-borne disease in Germany. In 9/16 states, notification of erythema migrans (EM), acute neuroborreliosis (NB) and Lyme arthritis (LA) is mandatory. We describe incidence measures, time trends, geographical distribution and frequencies of manifestations to better understand LB epidemiology and target prevention measures. We used cases notified in the 9 states and confirmed by local health offices, 2013-2017, to calculate incidences by time, place and person. Altogether, we observed 56,446 cases. Disease onset peaked yearly in July. Incidence ranged from 26/100,000 (2015) to 41/100,000 (2013) with mean annual incidences 2013-2017 on district level between 0.5/100,000 and 138/100,000. Median age was 54 years with peaks in boys (5-9 years, mean incidence 36/100,000) and women (50-69 years, mean incidence 57/100,000). 95% experienced EM only, 2.7% NB and 2.1% LA. 54% were female, but more men had NB (56%) and LA (53%, p < 0.001). Hospitalisation was recorded for 10% of LA and 71% of NB cases. LB remains an important public health concern in Germany with marked regional variation. To facilitate early diagnosis and treatment, health authorities should raise awareness among physicians and promote prevention strategies among the general population: tick-bite-protection, prompt tick removal and medical consultation.
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Affiliation(s)
- Julia Enkelmann
- Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany.
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | - Merle Böhmer
- Department of Public Health Microbiology & Infectious Disease Epidemiology and National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Volker Fingerle
- Department of Public Health Microbiology & Infectious Disease Epidemiology and National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Claudia Siffczyk
- Brandenburg State Office of Occupational Safety, Consumer Protection and Health, Potsdam, Germany
| | - Dirk Werber
- State Office for Health and Social Affairs, Berlin, Germany
| | - Martina Littmann
- State Office for Health and Social Affairs, Rostock, Mecklenburg-Western Pomerania, Germany
| | | | - Carina Helmeke
- State Agency for Consumer Protection of Saxony-Anhalt, Halle (Saale), Germany
| | - Sabine Schroeder
- Thuringian State Authority for Consumer Protection, Bad Langensalza, Germany
| | - Stefan Hell
- State Authority of Saarland for Social Affairs, Health, Women and Family, Berlin, Germany
| | - Uwe Schlotthauer
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Florian Burckhardt
- Federal State Agency for Consumer & Health Protection, Rhineland- Palatinate, Germany
| | - Klaus Stark
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Anika Schielke
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Hendrik Wilking
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Grillon A, Scherlinger M, Boyer PH, De Martino S, Perdriger A, Blasquez A, Wipff J, Korganow AS, Bonnard C, Cantagrel A, Eyer D, Guérin F, Monteiro I, Woehl JM, Moreau P, Pennaforte JL, Lechevallier J, Bastides F, Colombey A, Imbert I, Maugars Y, Gicquel P, Cuchet F, Brax M, Sibilia J, Zilliox L, Barthel C, Arnaud L, Jaulhac B. Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis. Semin Arthritis Rheum 2018; 48:1105-1112. [PMID: 30344080 DOI: 10.1016/j.semarthrit.2018.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/18/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe the clinical and microbiological characteristics and outcomes after antibiotic treatment of a national cohort of patients with Lyme arthritis confirmed by PCR testing on synovial fluid and by serology, when available. METHODS Using the French National Reference Center for Borrelia database, patients with a positive PCR on synovial fluid for Borrelia were identified. Patient clinical and biological characteristics were reviewed from patient records. Long-term outcomes after treatment were studied through a questionnaire and with follow-up data. RESULTS Among 357 synovial fluid testing by PCR between 2010 and 2016, 37 (10.4%) were positive for Borrelia. Patients' median age was 36 years (range 6-78) with 61% of men and 28% patients under 18. The presentation was monoarticular in 92% and the knee was involved in 97%. Contrary to the Borrelia species repartition in European ticks, B. burgdorferi sensu stricto was the most prevalent species found in synovial fluid (54%) followed by B. azfelii (29%) and B. garinii (17%). Antibiotic treatments were mainly composed of doxycycline (n = 24), ceftriaxone (n = 10) and amoxicillin (n = 6), for a median duration of 4 weeks (range 3-12). Despite a properly conducted treatment, 34% of patients (n = 12) developed persistent synovitis for at least 2 months (median duration 3 months, range 2-16). Among those, 3 developed systemic inflammatory oligo- or polyarthritis in previously unaffected joints with no signs of persistent infection (repeated PCR testing negative), which mandated Disease-Modifying Antirheumatic Drugs (DMARD) introduction, leading to remission. CONCLUSION In France and contrary to ticks ecology, Lyme arthritis is mainly caused by B. burgdorferi sensu stricto. Despite proper antibiotic therapy, roughly one third of patients may present persistent inflammatory synovitis and a small proportion may develop systemic arthritis. In such cases, complete remission can be reached using DMARD.
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Affiliation(s)
- Antoine Grillon
- EA 7290-Virulence bactérienne précoce, groupe borréliose de Lyme, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | | | - Pierre-Hugues Boyer
- EA 7290-Virulence bactérienne précoce, groupe borréliose de Lyme, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Sylvie De Martino
- EA 7290-Virulence bactérienne précoce, groupe borréliose de Lyme, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France; Centre National de Référence des Borrelia, CHRU Strasbourg, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Isabelle Imbert
- Service de Rhumatologie, Hôpital d'instruction des armées, Saint-Mandé, France
| | | | | | | | | | - Jean Sibilia
- Service de Rhumatologie, CHRU Strasbourg, France
| | - Laurence Zilliox
- Centre National de Référence des Borrelia, CHRU Strasbourg, France
| | - Cathy Barthel
- EA 7290-Virulence bactérienne précoce, groupe borréliose de Lyme, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | | | - Benoit Jaulhac
- EA 7290-Virulence bactérienne précoce, groupe borréliose de Lyme, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France; Centre National de Référence des Borrelia, CHRU Strasbourg, France
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Sertour N, Cotté V, Garnier M, Malandrin L, Ferquel E, Choumet V. Infection Kinetics and Tropism of Borrelia burgdorferi sensu lato in Mouse After Natural (via Ticks) or Artificial (Needle) Infection Depends on the Bacterial Strain. Front Microbiol 2018; 9:1722. [PMID: 30108573 PMCID: PMC6079464 DOI: 10.3389/fmicb.2018.01722] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/10/2018] [Indexed: 12/21/2022] Open
Abstract
Borrelia burgdorferi sl is a complex of pathogen bacteria transmitted to the host by Ixodes ticks. European Ixodes ricinus ticks transmit different B. burgdorferi species, pathogenic to human. Bacteria are principally present in unfed tick midgut, then migrate to salivary glands during blood meal and infect a new host via saliva. In this study, efficiency of transmission in a mouse model of three pathogen species belonging to the B. burgdorferi sl complex, B. burgdorferi sensu stricto (B31, N40, and BRE-13), B. afzelii (IBS-5), and B. bavariensis (PBi) is examined in order to evaluate infection risk after tick bite. We compared the dissemination of the Borrelia species in mice after tick bite and needle injection. Location in the ticks and transmission to mice were also determined for the three species by following infection kinetics. After inoculation, we found a significant prevalence in the brain for PBi and BRE-13, in the heart, for PBi, in the skin where B31 was more prevalent than PBi and in the ankle where both B31 and N40 were more present than PBi. After tick bite, statistical analyses showed that BRE-13 was more prevalent than N40 in the brain, in the bladder and in the inguinal lymph node. When Borrelia dissemination was compared after inoculation and tick bite, we observed heart infection only after tick inoculation of BRE-13, and PBi was only detected after tick bite in the skin. For N40, a higher number of positive organs was found after inoculation compared to tick bite. All European B. burgdorferi sl strains studied were detected in female salivary glands before blood meal and infected mice within 24 h of tick bite. Moreover, Borrelia-infected nymphs were able to infect mice as early as 12 h of tick attachment. Our study shows the need to remove ticks as early as possible after attachment. Moreover, Borrelia tropism varied according to the strain as well as between ticks bite and needle inoculation, confirming the association between some strains and clinical manifestation of Lyme borreliosis, as well as the role played by tick saliva in the efficiency of Borrelia infection and dissemination in vertebrates.
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Affiliation(s)
| | | | | | | | | | - Valérie Choumet
- CNR des Borrelia, Institut Pasteur, Paris, France.,Unité Environnement et Risques Infectieux, Institut Pasteur, Paris, France
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De Keukeleire M, Robert A, Luyasu V, Kabamba B, Vanwambeke SO. Seroprevalence of Borrelia burgdorferi in Belgian forestry workers and associated risk factors. Parasit Vectors 2018; 11:277. [PMID: 29716647 PMCID: PMC5930862 DOI: 10.1186/s13071-018-2860-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/19/2018] [Indexed: 02/01/2023] Open
Abstract
Background As forest is the preferred environment for ticks, forestry workers are exposed to tick bites and tick-borne diseases. We assessed the seroprevalence of anti-Borrelia burgdorferi (Bb) antibodies and investigated, using an integrated landscape approach, the individual and environmental factors associated with the seroprevalence of Bb in Belgian forestry workers, a high-risk group in Belgium. Methods A group of 310 Belgian forest workers was examined to assess the seroprevalence of anti-Borrelia IgG antibodies. Using principal component analysis and binary logistic regression, the joint effects of individual characteristics and environmental characteristics were examined. Results Sixty-seven of the 310 workers were seropositive for Lyme disease (LD), leading to a seroprevalence of 21.6%. The seroprevalence was higher among forest workers visiting forests more frequently (P = 0.003) or who reported over 100 tick bites (P-value < 0.001). The intensity of tick bites and the use of protection measures against tick bites have a positive impact on LD seroprevalence while the quantity of shadow from trees at ground level had a negative one. Conclusions This study showed that forest workers are a population at risk for LD and, by extension, at risk for various tick-borne diseases. In addition to the role of the environment, our results also showed the importance of considering exposure when predicting the risk of infection by Bb.
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Affiliation(s)
- Mathilde De Keukeleire
- Earth and Life Institute (ELI), Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgique. .,Pôle Epidémiologie et Biostatistique (EPID), Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgique.
| | - Annie Robert
- Pôle Epidémiologie et Biostatistique (EPID), Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgique
| | - Victor Luyasu
- Pôle Epidémiologie et Biostatistique (EPID), Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgique
| | - Benoît Kabamba
- Laboratory of Medical Microbiology, Université Catholique de Louvain (UCL), Bruxelles, Belgique
| | - Sophie O Vanwambeke
- Earth and Life Institute (ELI), Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgique
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Abstract
We investigated the epidemiology of Lyme borreliosis (LB) in Finland for the period 1995–2014 by using data from 3 different healthcare registers. We reviewed data on disseminated LB cases from the National Infectious Diseases Register (21,051 cases) and the National Hospital Discharge Register (10,402 cases) and data on primary LB (erythema migrans) cases from the Register for Primary Health Care Visits (11,793 cases). Incidence of microbiologically confirmed disseminated LB cases increased from 7/100,000 population in 1995 to 31/100,000 in 2014. Incidence of primary LB cases increased from 44/100,000 in 2011 to 61/100,000 in 2014. Overall, cases occurred predominantly in women, and we observed a bimodal age distribution in all 3 registers. Our results clearly demonstrate that the geographic distribution of LB has expanded in Finland and underscore the importance of LB as an increasing public health concern in Finland and in northern Europe in general.
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Goldstein V, Boulanger N, Schwartz D, George JC, Ertlen D, Zilliox L, Schaeffer M, Jaulhac B. Factors responsible for Ixodes ricinus nymph abundance: Are soil features indicators of tick abundance in a French region where Lyme borreliosis is endemic? Ticks Tick Borne Dis 2018; 9:938-944. [PMID: 29606622 DOI: 10.1016/j.ttbdis.2018.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 03/11/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
In Europe, the hard tick Ixodes ricinus (Acari: Ixodidae) is the main vector of Lyme borreliosis spirochetes (Borrelia burgdorferi sensu lato group). A field study was conducted to evaluate the abundance of Ixodes nymphs in the French region of Alsace, where Lyme borreliosis is endemic, and to determine whether environmental factors such as soil moisture and composition may be associated with nymph abundance. In the ten sites studied, ticks were collected by drag sampling from March to October in 2013 and 2014. Temperature, relative humidity, saturation deficit, soil pH, humus composition and type of vegetation were recorded at each site. The abundance of I. ricinus was highly variable from one site to another. Inter-annual variations were also observed, since the nymph abundance were higher in 2013 than in 2014. This study shows that humus type can be indicative of nymph abundance. Three types of humus were observed: (1) moder, (2) mull, and (3) mull-moder humus. One of them, moder humus, which is characterized by a thick layer of fragmented leaves, was found in multivariate analyses to be strongly associated with the nymph abundance. This study demonstrates that factors such as saturation deficit do not suffice to explain the differences in nymph abundance among sites. The composition of the soil and especially the type of humus should also be taken into consideration when assessing acarological risk.
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Affiliation(s)
- Valérie Goldstein
- EA 7290: Virulence bactérienne précoce: groupe Borréliose de Lyme, Facultés de pharmacie et de médecine, Université de Strasbourg, 3 rue Koeberlé, 67097, Strasbourg, France
| | - Nathalie Boulanger
- EA 7290: Virulence bactérienne précoce: groupe Borréliose de Lyme, Facultés de pharmacie et de médecine, Université de Strasbourg, 3 rue Koeberlé, 67097, Strasbourg, France; Centre National de Référence des Borrelia, Centre hospitalier universitaire, Strasbourg, 3 rue Koeberlé, 67097, Strasbourg, France.
| | - Dominique Schwartz
- UMR 7362, Laboratoire Image, Ville et Environnement, Faculté de géographie, Université de Strasbourg, 3 rue de l'Argonne, 67000, Strasbourg, France
| | - Jean-Claude George
- Centre National de Référence des Borrelia, Centre hospitalier universitaire, Strasbourg, 3 rue Koeberlé, 67097, Strasbourg, France
| | - Damien Ertlen
- UMR 7362, Laboratoire Image, Ville et Environnement, Faculté de géographie, Université de Strasbourg, 3 rue de l'Argonne, 67000, Strasbourg, France
| | - Laurence Zilliox
- Centre National de Référence des Borrelia, Centre hospitalier universitaire, Strasbourg, 3 rue Koeberlé, 67097, Strasbourg, France
| | - Mickaël Schaeffer
- Département d'Information Médicale, Centre hospitalier universitaire, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Benoît Jaulhac
- EA 7290: Virulence bactérienne précoce: groupe Borréliose de Lyme, Facultés de pharmacie et de médecine, Université de Strasbourg, 3 rue Koeberlé, 67097, Strasbourg, France; Centre National de Référence des Borrelia, Centre hospitalier universitaire, Strasbourg, 3 rue Koeberlé, 67097, Strasbourg, France
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van den Wijngaard CC, Hofhuis A, Simões M, Rood E, van Pelt W, Zeller H, Van Bortel W. Surveillance perspective on Lyme borreliosis across the European Union and European Economic Area. ACTA ACUST UNITED AC 2017; 22. [PMID: 28703098 PMCID: PMC5508331 DOI: 10.2807/1560-7917.es.2017.22.27.30569] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/05/2017] [Indexed: 11/20/2022]
Abstract
Lyme borreliosis (LB) is the most prevalent tick-borne disease in Europe. Erythema migrans (EM), an early, localised skin rash, is its most common presentation. Dissemination of the bacteria can lead to more severe manifestations including skin, neurological, cardiac, musculoskeletal and ocular manifestations. Comparison of LB incidence rates in the European Union (EU)/European Economic Area (EEA) and Balkan countries are difficult in the absence of standardised surveillance and reporting procedures. We explored six surveillance scenarios for LB surveillance in the EU/EEA, based on the following key indicators: (i) erythema migrans, (ii) neuroborreliosis, (iii) all human LB manifestations, (iv) seroprevalence, (v) tick bites, and (vi) infected ticks and reservoir hosts. In our opinion, neuroborreliosis seems most feasible and useful as the standard key indicator, being one of the most frequent severe LB manifestations, with the possibility of a specific case definition. Additional surveillance with erythema migrans as key indicator would add value to the surveillance of neuroborreliosis and lead to a more complete picture of LB epidemiology in the EU/EEA. The other scenarios have less value as a basis for EU-level surveillance, but can be considered periodically and locally, as they could supply complementary insights.
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Affiliation(s)
- Cees C van den Wijngaard
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Agnetha Hofhuis
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mariana Simões
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Ente Rood
- Epidemiology Unit, KIT (Royal Tropical Institute) Health, Amsterdam, the Netherlands
| | - Wilfrid van Pelt
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Herve Zeller
- Office of the Chief Scientist, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Wim Van Bortel
- Surveillance and Response Support Unit, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden (affiliation when the work was performed).,Institute of Tropical Medicine, Antwerp, Belgium (current affiliation)
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De Keukeleire M, Vanwambeke SO, Kabamba B, Belkhir L, Pierre P, Luyasu V, Robert A. Time trend of clinical cases of Lyme disease in two hospitals in Belgium, 2000-2013. BMC Infect Dis 2017; 17:748. [PMID: 29207940 PMCID: PMC5718134 DOI: 10.1186/s12879-017-2841-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND As several studies indicated an increase in Lyme disease (LD), notably in neighbouring countries, concerns have arisen regarding the evolution of Lyme disease in Belgium. In order to confirm or infirm the increase of LD in Belgium, we focused on hospital admissions of patients diagnosed with LD between 2000 and 2013 based on hospital admission databases from two hospitals in Belgium. METHODS Hospital databases are a stable recording system. We did a retrospective analysis of the medical files of patients hospitalized with Lyme disease in two Belgian hospitals between 2000 and 2013. RESULTS The annual number of cases of LD for the two studied Belgian hospitals remained stable between 2000 and 2013, ranging from 1 for the Cliniques universitaires Saint-Luc to 15 for the the Clinique Saint-Pierre. No increasing trend were noted in the estimated annual incidence rate but the average estimated annual incidence rate was higher for the hospital Saint-Pierre (8.1 ± 3.7 per 100,000 inhabitants) than Saint-Luc (2.2 ± 1.5 per 100,000 inhabitants). The number of hospital cases of LD peaked between June and November. CONCLUSIONS Based on hospital admissions with LD, no increasing trend was observed for the period 2000-2013 in the two studied Belgian hospitals. This is in line with other studies carried out in Belgium.
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Affiliation(s)
- Mathilde De Keukeleire
- Earth and Life Institute (ELI), Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle Epidémiologie et Biostatistique, Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgium
| | - Sophie O. Vanwambeke
- Earth and Life Institute (ELI), Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium
| | - Benoît Kabamba
- Division of Clinical Biology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCL), Bruxelles, Belgium
| | - Leila Belkhir
- Department of Internal medicine and infectious diseases, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCL), Bruxelles, Belgium
| | - Philippe Pierre
- Neurology Department, Cliniques St-Pierre, Ottignies, Belgium
| | - Victor Luyasu
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle Epidémiologie et Biostatistique, Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgium
| | - Annie Robert
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle Epidémiologie et Biostatistique, Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgium
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Wilson RT, Hasanali SH, Sheikh M, Cramer S, Weinberg G, Firth A, Weiss SH, Soskolne CL. Challenges to the census: international trends and a need to consider public health benefits. Public Health 2017; 151:87-97. [PMID: 28759883 DOI: 10.1016/j.puhe.2017.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/10/2017] [Accepted: 05/21/2017] [Indexed: 02/05/2023]
Abstract
The Canadian government decision to cancel the mandatory long-form census in 2010 (subsequently restored in 2015), along with similar discussions in the United Kingdom (UK) and the United States of America (USA), have brought the purpose and use of census data into focus for epidemiologists and public health professionals. Policy decision-makers should be well-versed in the public health importance of accurate and reliable census data for emergency preparedness planning, controlling disease outbreaks, and for addressing health concerns among vulnerable populations including the elderly, low-income, racial/ethnic minorities, and special residential groups (e.g., nursing homes). Valid census information is critical to ensure that policy makers and public health practitioners have the evidence needed to: (1) establish incidence rates, mortality rates, and prevalence for the full characterization of emerging health issues; (2) address disparities in health care, prevention strategies and health outcomes among vulnerable populations; and (3) plan and effectively respond in times of disaster and emergency. At a time when budget and sample size cuts have been implemented in the UK, a voluntary census is being debated in the US. In Canada, elimination of the mandatory long-form census in 2011 resulted in unreliable population enumeration, as well as a substantial waste of money and resources for taxpayers, businesses and communities. The purpose of this article is to provide a brief overview of recent international trends and to review the foundational role of the census in public health management and planning using historical and current examples of environmental contamination, cancer clusters and emerging infections. Citing a general absence of public health applications of the census in cost-benefit analyses, we call on policy makers to consider its application to emergency preparedness, outbreak response, and chronic disease prevention efforts. At the same time, we call on public health professionals to improve published estimates of monetary benefit (via either cost-benefit or cost-effectiveness analysis) to a given public health intervention.
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Affiliation(s)
- R T Wilson
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, United States.
| | - S H Hasanali
- Department of Sociology and Criminology, Program in Demography, Pennsylvania State University, State College, PA 16801, United States.
| | - M Sheikh
- Department of Economics, Carleton University, Ottawa, Ontario K1S 5B6, Canada.
| | - S Cramer
- Royal Society for Public Health, John Snow House, 59 Mansell Street, London, E1 8AN, United Kingdom
| | - G Weinberg
- Bureau of Epidemiology, Pennsylvania Department of Health, Health and Welfare Building, 625 Forster Street, Harrisburg, PA, 17120, United States.
| | - A Firth
- Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, WC1X 8SH, United Kingdom.
| | - S H Weiss
- Department of Medicine, Rutgers New Jersey Medical School, 30 Bergen Street, Suite 1614, Newark, NJ, 07103, United States.
| | - C L Soskolne
- University of Alberta, 11405 87 Ave, Edmonton, Alberta T6G 1C9, Canada; Health Research Institute, University of Canberra, University Drive, Bruce ACT 2617, Australia.
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Marchant A, Le Coupanec A, Joly C, Perthame E, Sertour N, Garnier M, Godard V, Ferquel E, Choumet V. Infection of Ixodes ricinus by Borrelia burgdorferi sensu lato in peri-urban forests of France. PLoS One 2017; 12:e0183543. [PMID: 28846709 PMCID: PMC5573218 DOI: 10.1371/journal.pone.0183543] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/07/2017] [Indexed: 12/21/2022] Open
Abstract
Lyme borreliosis is the most common tick-borne disease in the northern hemisphere. In Europe, it is transmitted by Ixodes ticks that carry bacteria belonging to the Borrelia burgdorferi sensu lato complex. The objective of this work was to explore eco-epidemiological factors of Lyme borreliosis in peri-urban forests of France (Sénart, Notre-Dame and Rambouillet). We investigated whether the introduction of Tamias sibiricus in Sénart could alter the density of infected ticks. Moreover, the density and tick infection were investigated according to the tree species found in various patches of Sénart forest. For this purpose, ticks were sampled during 3 years. In the Sénart forest, the density of nymph and adult ticks showed no significant difference between 2008, 2009 and 2011. The nymph density varied significantly as a function of the month of collection. Regarding the nymphs, a higher rate of infection and infected density were found in 2009. Plots with chipmunks (C) presented a lower density of both nymphs and adult ticks than plots without chipmunks (NC) did. A higher rate of infection of nymphs with Borrelia was seen in C plots. The prevalence of the various species of Borrelia was also found to vary between C and NC plots with the year of the collect. The presence of chestnut trees positively influenced the density of both nymphs and adults. The infected nymph density showed a significant difference depending on the peri-urban forest studied, Sénart being higher than Rambouillet. The prevalence of Borrelia species also differed between the various forests studied. Concerning the putative role that Tamias sibiricus may play in the transmission of Borrelia, our results suggest that its presence is correlated with a higher rate of infection of questing ticks by Borrelia genospecies and if its population increases, it could play a significant role in the risk of transmission of Lyme borreliosis.
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Affiliation(s)
- Axelle Marchant
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Alain Le Coupanec
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Claire Joly
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Emeline Perthame
- Institut Pasteur – Bioinformatics and Biostatistics Hub – C3BI, USR 3756 IP CNRS –Bioinformatique et Biostatistique, Paris, France
| | - Natacha Sertour
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Martine Garnier
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Vincent Godard
- CNRS-UMR7533/LADYSS, Université de Paris 8 - Saint-Denis, France
| | - Elisabeth Ferquel
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Valerie Choumet
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
- Unité Environnement et Risques Infectieux, Institut Pasteur, Paris, France
- * E-mail:
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Geebelen L, Lernout T, Kabamba-Mukadi B, Saegeman V, Sprong H, Van Gucht S, Beutels P, Speybroeck N, Tersago K. The HUMTICK study: protocol for a prospective cohort study on post-treatment Lyme disease syndrome and the disease and cost burden of Lyme borreliosis in Belgium. ACTA ACUST UNITED AC 2017; 75:42. [PMID: 28794875 PMCID: PMC5545865 DOI: 10.1186/s13690-017-0202-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/05/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Belgium, different routine surveillance systems are in place to follow-up Lyme borreliosis trends. However, accurate data on the disease and monetary burden for the different clinical manifestations are lacking. Despite recommended antibiotic treatment, a proportion of Lyme patients report persisting aspecific symptoms for six months or more (e.g. fatigue, widespread musculoskeletal pain, cognitive difficulties), a syndrome now named "post-treatment Lyme disease syndrome" (PTLDS). Controversy exists on the cause, incidence and severity of PTLDS. This study aims to estimate the incidence of PTLDS in patients with Lyme borreliosis and to quantify the disease burden and economic costs associated with the different clinical manifestations of Lyme borreliosis in Belgium. METHODS The project is a prospective cohort study in which about 600 patients with an erythema migrans and 100 patients with disseminated Lyme borreliosis will be followed up. Questionnaires, including the SF-36 vitality and pain subscale, the Cognitive Failure Questionnaire and the EQ-5D-5L, will be used to collect information on acute and persisting symptoms and the impact on quality of life. Symptom frequency and severity will be compared with self-reported pre-Lyme health status, a control group and existing Belgian population norms. Additionally, information on the associated costs and possible risk factors for the development of PTLDS will be collected. DISCUSSION A study of the health burden will allow evaluation of the relative importance of Lyme borreliosis in Belgium and information on the economic cost will help to formulate cost-effective measures. There are only few prospective studies conducted estimating the incidence of PTLDS and even though discussion exists about the prevalence of subjective symptoms in the general population, a control group of non-Lyme borreliosis participants has often not been included.
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Affiliation(s)
- Laurence Geebelen
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Tinne Lernout
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Benoît Kabamba-Mukadi
- Laboratory of Medical Microbiology, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Veroniek Saegeman
- Department of Microbiology, University Hospitals Leuven, Leuven, Belgium
| | - Hein Sprong
- Laboratory for Zoonoses and Environmental Microbiology, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | - Steven Van Gucht
- Viral Diseases, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Katrien Tersago
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
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Boyer PH, De Martino SJ, Hansmann Y, Zilliox L, Boulanger N, Jaulhac B. No evidence of Borrelia mayonii in an endemic area for Lyme borreliosis in France. Parasit Vectors 2017; 10:282. [PMID: 28583197 DOI: 10.1186/s13071-017-2212-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/22/2017] [Indexed: 12/30/2022] Open
Abstract
Background Borrelia mayonii is currently the latest species belonging to the Borrelia burgdorferi (sensu lato) complex to be discovered. Interestingly it is involved in human pathology causing a high fever. We looked for its presence in post- tick bite febrile patients as well as in Ixodes ricinus ticks in an endemic area of France. Results After ensuring that our molecular technics correctly detected B. mayonii, 575 patients and 3,122 Ixodes ricinus nymphs were tested. Neither B. mayonii nor another species of the B. burgdorferi (s.l.) complex previously not reported in Europe has been identified. Conclusions For now, B. mayonii seems to be an epiphenomenon. However, its discovery broadens the etiology of post-Ixodes bite febrile syndromes.
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De Keukeleire M, Vanwambeke SO, Cochez C, Heyman P, Fretin D, Deneys V, Luyasu V, Kabamba B, Robert A. Seroprevalence of Borrelia burgdorferi, Anaplasma phagocytophilum, and Francisella tularensis Infections in Belgium: Results of Three Population-Based Samples. Vector Borne Zoonotic Dis 2016; 17:108-115. [PMID: 27828762 DOI: 10.1089/vbz.2016.1954] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To estimate the seroprevalence of Borrelia burgdorferi (Bb), Anaplasma phagocytophilum (Ap), and Francisella tularensis (Ft) in Belgium, we tested sera from three population-based samples in which exposure to pathogen is assumed to vary: 148 samples from workers professionally exposed, 209 samples from rural blood donors, and 193 samples from urban blood donors. Sera were tested using ELISA or the immunofluorescence assay test. The seroprevalence of Bb was 5.4% in workers professionally exposed, 2.9% in rural blood donors, and 2.6% in urban blood donors, which is similar to other studies. The fraction of negative results decreases significantly from urban blood donors and rural blood donors to workers. Regarding the seroprevalence of Ap, the cutoff titer of 1:64 recommended by the manufacturer may be set too low and produces artificially high seroprevalence rates. Using a cutoff titer of 1:128, the seroprevalence of Ap was estimated at 8.1% for workers professionally exposed, 6.2% for rural blood donors, and 5.7% for urban blood donors. Tularemia sera confirmed the presence of the pathogen in Belgium at 2.0% for workers and 0.5% for rural and urban blood donors. Our study is one of the few providing an estimation of the seroprevalences of Bb, Ap, and Ft in three different populations in Belgium, filling the gap in seroprevalence data among those groups. Our findings provide evidence that the entire Belgian population is exposed to Bb, Ap, and Ft infections, but a higher exposure is noticed for professionals at risk. Education on the risk factors for tick bites and preventive measures for both professionals exposed and the general population is needed.
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Affiliation(s)
- Mathilde De Keukeleire
- 1 Earth and Life Institute (ELI) , Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium .,2 Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL) , Brussels, Belgium
| | - Sophie O Vanwambeke
- 1 Earth and Life Institute (ELI) , Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium
| | - Christel Cochez
- 3 Research Laboratory for Vector-Borne Diseases, Queen Astrid Military Hospital , Brussels, Belgium
| | - Paul Heyman
- 3 Research Laboratory for Vector-Borne Diseases, Queen Astrid Military Hospital , Brussels, Belgium
| | - David Fretin
- 4 Veterinary and Agrochemical Research Center (CERVA) , Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Brussels, Belgium
| | - Véronique Deneys
- 5 Blood Transfusion Service of Mont-Godinne and CHU UCL Namur, Yvoir, Belgium
| | - Victor Luyasu
- 2 Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL) , Brussels, Belgium
| | - Benoît Kabamba
- 6 Division of Clinical Biology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL) , Brussels, Belgium
| | - Annie Robert
- 2 Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL) , Brussels, Belgium
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MacDonald E, Vestrheim DF, White RA, Konsmo K, Lange H, Aase A, Nygård K, Stefanoff P, Aaberge I, Vold L. Are the current notification criteria for Lyme borreliosis in Norway suitable? Results of an evaluation of Lyme borreliosis surveillance in Norway, 1995-2013. BMC Public Health 2016; 16:729. [PMID: 27495236 PMCID: PMC4974730 DOI: 10.1186/s12889-016-3346-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/22/2016] [Indexed: 12/03/2022] Open
Abstract
Background The approach to surveillance of Lyme borreliosis varies between countries, depending on the purpose of the surveillance system and the notification criteria used, which prevents direct comparison of national data. In Norway, Lyme borreliosis is notifiable to the Surveillance System for Communicable Diseases (MSIS). The current notification criteria include a combination of clinical and laboratory results for borrelia infection (excluding Erythema migrans) but there are indications that these criteria are not followed consistently by clinicians and by laboratories. Therefore, an evaluation of Lyme borreliosis surveillance in Norway was conducted to describe the purpose of the system and to assess the suitability of the current notification criteria in order to identify areas for improvement. Methods The CDC Guidelines for Evaluation of Surveillance Systems were used to develop the assessment of the data quality, representativeness and acceptability of MSIS for surveillance of Lyme borreliosis. Data quality was assessed through a review of data from 1996 to 2013 in MSIS and a linkage of MSIS data from 2008 to 2012 with data from the Norwegian Patient Registry (NPR). Representativeness and acceptability were assessed through a survey sent to 23 diagnostic laboratories. Results Completeness of key variables for cases reported to MSIS was high, except for geographical location of exposureThe NPR-MSIS linkage identified 1047 cases in both registries, while 363 were only reported to MSIS and 3914 were only recorded in NPR. A higher proportion of cases found in both registries were recorded as neuroborreliosis in MSIS (84.4 %) than those cases found only in MSIS (20.1 %). The trend (average yearly increase or decrease in reported cases) of neuroborreliosis in MSIS was not significantly different from the trend for all other clinical manifestations recorded in MSIS in negative binomial regression (p = 0.3). The 16 surveyed laboratories (response proportion 70 %) indicated differences in testing practices and low acceptability of the notification criteria. Conclusions Given the challenges associated with diagnosing Lyme borreliosis, the selected notification criteria should be closely linked with the purpose of the surveillance system. Restricting reportable Lyme borreliosis to neuroborreliosis may increase validity, while a more sensitive case definition (potentially including erythema migrans) may better reflect the true burden of disease. We recommend revising the current notification criteria in Norway to ensure that they are unambiguous for clinicians and laboratories.
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Affiliation(s)
- Emily MacDonald
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway. .,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden.
| | - Didrik Frimann Vestrheim
- Department Bacteriology and Immunology Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.,European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Richard A White
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway.,Department of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway
| | - Kirstin Konsmo
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway
| | - Heidi Lange
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Audun Aase
- Department Bacteriology and Immunology Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Karin Nygård
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway
| | - Pawel Stefanoff
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Ingeborg Aaberge
- Department Bacteriology and Immunology Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Line Vold
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway
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Eliassen KE, Berild D, Reiso H, Grude N, Christophersen KS, Finckenhagen C, Lindbæk M. Incidence and antibiotic treatment of erythema migrans in Norway 2005-2009. Ticks Tick Borne Dis 2016; 8:1-8. [PMID: 27475874 DOI: 10.1016/j.ttbdis.2016.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 12/31/2022]
Abstract
The first stage of Lyme borreliosis (LB) is mainly the typical skin lesion, erythema migrans (EM), which is estimated to comprise 80-90% of all LB cases. However, the reporting of, and the actual incidence of LB varies throughout Europe. Studies from Sweden and Holland have found EM incidences varying from 53 to 464 EM/100,000 inhabitants/year. Under-reporting of LB is common and a coefficient of three to reach a realistic estimate is suggested. In Norway, it is mandatory to report only the second and third LB stages to the National Institute of Public Health. To find the Norwegian incidence of EM, we extracted data from the electronic medical records of regular general practitioners and out-of-hours services in the four counties with the highest rates of registered LB in the 5 years from 2005 to 2009. We found an EM incidence of 448 EM/100,000 inhabitants/year in these counties, which yields a national incidence of 148 EM/100,000 inhabitants/year. Our findings show that solitary EMs comprised almost 96% of the total LB incidence in Norway. Older females have the highest rates of EM. Phenoxymethylpenicillin is the most commonly used drug to treat EM in Norway, which complies with the national guidelines for antibiotic use. Antibody tests are performed in 15% of cases. Less than 1% of patients are referred to secondary care. The study also shows a high number of patients seeking care for tick bites without signs of infection and there is an overuse of antibiotics in these patients.
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Affiliation(s)
- Knut Eirik Eliassen
- Norwegian Antibiotic Centre for Primary Care, Department of General Practice, University of Oslo, PO box 1130 Blindern, N-0318 Oslo, Norway.
| | - Dag Berild
- Department of Infectious Diseases, Oslo University Hospital, Faculty of Medicine, University of Oslo, Kirkeveien 166, N-0460 Oslo, Norway.
| | - Harald Reiso
- Norwegian National Advisory Unit on Tick-borne Diseases, Sorlandet Hospital, PO box 783 Stoa, N-4809 Arendal, Norway.
| | - Nils Grude
- Department of Medical Microbiology, Vestfold Hospital Trust, Halfdan Wilhelmsens allè 17, N-3116 Tonsberg, Norway.
| | | | - Cecilie Finckenhagen
- Asker and Baerum Primary Care Out-of-hours Service, Sogneprest Munthe-kaas vei 100, N-1346 Gjettum, Norway.
| | - Morten Lindbæk
- Norwegian Antibiotic Centre for Primary Care, Department of General Practice, University of Oslo, PO box 1130 Blindern, N-0318 Oslo, Norway.
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N’Guyen Y, Lesaffre F, Metz D, de Martino S, Jaulhac B, Andréoletti L. No serological evidence for Borrelia burgdorferi sensu lato infection in patients with dilated cardiomyopathy in Northern France. Infect Dis (Lond) 2016; 48:763-4. [DOI: 10.1080/23744235.2016.1193790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Yohan N’Guyen
- Laboratoire de Virologie médicale et moléculaire, Centre hospitalier universitaire de Reims, Reims, France
- EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
| | - François Lesaffre
- EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
- Service de Cardiologie, Centre hospitalier universitaire de Reims, France
| | - Damien Metz
- EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
- Service de Cardiologie, Centre hospitalier universitaire de Reims, France
| | - Sylvie de Martino
- Laboratoire de Bactériologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Benoit Jaulhac
- Laboratoire de Bactériologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Laurent Andréoletti
- Laboratoire de Virologie médicale et moléculaire, Centre hospitalier universitaire de Reims, Reims, France
- EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
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Rigaud E, Jaulhac B, Garcia-Bonnet N, Hunfeld KP, Féménia F, Huet D, Goulvestre C, Vaillant V, Deffontaines G, Abadia-Benoist G. Seroprevalence of seven pathogens transmitted by the Ixodes ricinus tick in forestry workers in France. Clin Microbiol Infect 2016; 22:735.e1-9. [PMID: 27237545 DOI: 10.1016/j.cmi.2016.05.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/13/2016] [Accepted: 05/14/2016] [Indexed: 12/30/2022]
Abstract
In order to assess the level of occupational exposure to the main pathogens transmitted by the Ixodes ricinus tick, a seroprevalence study was performed on serum samples collected in 2003 from 2975 forestry workers of northeastern France. The global seroprevalence estimated for the seven pathogens studied was 14.1% (419/2975) for Borrelia burgdorferi sl, 5.7% (164/2908) for Francisella tularensis, 2.3% (68/2941) for tick-borne encephalitis virus, 1.7% (50/2908) for Anaplasma phagocytophilum and 1.7% (48/2908) for Bartonella henselae. The seroprevalences of Babesia divergens and Babesia microti studied in a subgroup of participants seropositive for at least one of these latter pathogens were 0.1% (1/810) and 2.5% (20/810), respectively. Borrelia burgdorferi sl seroprevalence was significantly higher in Alsace and Lorraine and F. tularensis seroprevalence was significantly higher in Champagne-Ardenne and Franche-Comté. The results of this survey also suggest low rates of transmission of Bartonella henselae and F. tularensis by ticks and a different west/east distribution of Babesia species in France. The frequency and potential severity of these diseases justify continued promotion of methods of prevention of I. ricinus bites.
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Affiliation(s)
- E Rigaud
- Caisse Centrale de la Mutualité Sociale Agricole, Direction santé sécurité au travail, Bagnolet, France.
| | - B Jaulhac
- EA7290 Virulence Bactérienne Précoce, Centre National de Référence des Borrelia, Groupe d'Etude de la Borréliose de Lyme (GEBLY), Fédération de Médecine Translationnelle de Strasbourg, Institut de Bactériologie, Université de Strasbourg, CHRU Strasbourg, France
| | - N Garcia-Bonnet
- Hôpital Avicenne, Maladies Infectieuses et Tropicales, formerly Caisse Centrale de la Mutualité Sociale Agricole, Bobigny, France
| | - K-P Hunfeld
- Institute for Laboratory Medicine, Northwest Medical Center, Academic Teaching Hospital, School of Medicine, The Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - F Féménia
- INRA, UMR BIPAR, INRA, Anses, ENVA, Maisons-Alfort, France
| | - D Huet
- INRA, UMR BIPAR, INRA, Anses, ENVA, Maisons-Alfort, France
| | - C Goulvestre
- INRA, UMR BIPAR, INRA, Anses, ENVA, Maisons-Alfort, France
| | - V Vaillant
- Institut de Veille Sanitaire, Saint-Maurice, France
| | - G Deffontaines
- Caisse Centrale de la Mutualité Sociale Agricole, Direction santé sécurité au travail, Bagnolet, France
| | - G Abadia-Benoist
- AFOMETRA, formerly Caisse Centrale de la Mutualité Sociale Agricole, Paris, France
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Hofhuis A, Bennema S, Harms M, van Vliet AJH, Takken W, van den Wijngaard CC, van Pelt W. Decrease in tick bite consultations and stabilization of early Lyme borreliosis in the Netherlands in 2014 after 15 years of continuous increase. BMC Public Health 2016; 16:425. [PMID: 27216719 PMCID: PMC4877959 DOI: 10.1186/s12889-016-3105-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nationwide surveys have shown a threefold increase in general practitioner (GP) consultations for tick bites and early Lyme borreliosis from 1994 to 2009 in the Netherlands. We now report an update on 2014, with identical methods as for the preceding GP surveys. METHODS To all GPs in the Netherlands, a postal questionnaire was sent inquiring about the number of consultations for tick bites and erythema migrans diagnoses (most common manifestation of early Lyme borreliosis) in 2014, and the size of their practice populations. RESULTS Contrasting to the previously rising incidence of consultations for tick bites between 1994 and 2009, the incidence decreased in 2014 to 488 consultations for tick bites per 100,000 inhabitants, i.e., 82,000 patients nationwide. This survey revealed a first sign of stabilization of the previously rising trend in GP diagnosed erythema migrans, with 140 diagnoses per 100,000 inhabitants of the Netherlands. This equals about 23,500 annual diagnoses of erythema migrans nationwide in 2014. CONCLUSIONS In contrast to the constantly rising incidence of GP consultations for tick bites and erythema migrans diagnoses in the Netherlands between 1994 and 2009, the current survey of 2014 showed a first sign of stabilization of erythema migrans diagnoses and a decreased incidence for tick bite consultations.
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Affiliation(s)
- Agnetha Hofhuis
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Sita Bennema
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Margriet Harms
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arnold J H van Vliet
- Environmental Systems Analysis Group, Wageningen University, Wageningen, The Netherlands
| | - Willem Takken
- Laboratory of Entomology, Wageningen University, Wageningen, The Netherlands
| | - Cees C van den Wijngaard
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wilfrid van Pelt
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Abstract
Lyme disease is the most common vector-borne illness in North America and Europe. The etiologic agent, Borrelia burgdorferi sensu lato, is transmitted to humans by certain species of Ixodes ticks, which are found widely in temperate regions of the Northern hemisphere. Clinical features are diverse, but death is rare. The risk of human infection is determined by the geographic distribution of vector tick species, ecologic factors that influence tick infection rates, and human behaviors that promote tick bite. Rates of infection are highest among children 5 to 15 years old and adults older than 50 years.
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Affiliation(s)
- Paul S Mead
- Epidemiology and Surveillance Activity, Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), 3156 Rampart Road, Fort Collins, CO 80521, USA.
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46
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Bleyenheuft C, Lernout T, Berger N, Rebolledo J, Leroy M, Robert A, Quoilin S. Epidemiological situation of Lyme borreliosis in Belgium, 2003 to 2012. ACTA ACUST UNITED AC 2015; 73:33. [PMID: 26146553 PMCID: PMC4490618 DOI: 10.1186/s13690-015-0079-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/05/2015] [Indexed: 11/22/2022]
Abstract
Background Some studies show that the incidence of Lyme borreliosis is increasing in different European countries. In order to evaluate if this is also the case in Belgium, different data sources were consulted to describe the epidemiology of Lyme borreliosis in the country during the last decade. Methods Data from two databases were analyzed for the time period 2003–2010 and 2003–2012 for respectively: the registration of minimal clinical data from Belgian hospitals (principal and secondary diagnosis), and a sentinel laboratory network reporting positive laboratory results. Results The number of hospitalized cases per year remained stable between 2003 and 2010, ranging from 970 (in 2008) to 1453 (in 2006), with a median of 1132.5 cases per year. Between 2003 and 2012, yearly fluctuations in the number of positive tests were reported by the sentinel laboratory network (with a minimum of 996 positive tests in 2007 and a maximum of 1651 positive tests in 2005), but there is no increasing trend over the study period (median = 1200.5 positive tests per year). The highest incidence rates of hospitalization and the highest reported incidence of positive laboratory results are registered in the provinces of Luxemburg, Limburg, Flemish Brabant and Antwerp, with a typical seasonal pattern (peak in September). The age groups affected most are those from 5 to 14 years and 45 to 69. Conclusion Based on hospital records and laboratory results, no increasing trend in Lyme disease was observed over the 2003–2012 period in Belgium. These results are in line with the stable incidence of erythema migrans reported by a sentinel network of general practitionners between 2003 and 2009. Multi-source surveillance of vector-borne diseases should be further implemented.
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Affiliation(s)
- Corinne Bleyenheuft
- WIV-ISP (Scientific Institute of Public Health), Rue Juliette Wytsmanstraat, 14, 1050 Brussels, Belgium
| | - Tinne Lernout
- WIV-ISP (Scientific Institute of Public Health), Rue Juliette Wytsmanstraat, 14, 1050 Brussels, Belgium
| | - Nicolas Berger
- WIV-ISP (Scientific Institute of Public Health), Rue Juliette Wytsmanstraat, 14, 1050 Brussels, Belgium ; Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Javiera Rebolledo
- WIV-ISP (Scientific Institute of Public Health), Rue Juliette Wytsmanstraat, 14, 1050 Brussels, Belgium
| | - Mathias Leroy
- WIV-ISP (Scientific Institute of Public Health), Rue Juliette Wytsmanstraat, 14, 1050 Brussels, Belgium
| | - Annie Robert
- Université catholique de Louvain - Brussels Campus, Institut de recherche expérimentale et clinique, Pôle de recherche Épidémiologie et Biostatistique, Public Health School -IREC-EPID B1.30.13, Clos chapelle aux champs 30, 1200 Brussels, Belgium
| | - Sophie Quoilin
- WIV-ISP (Scientific Institute of Public Health), Rue Juliette Wytsmanstraat, 14, 1050 Brussels, Belgium
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De Keukeleire M, Vanwambeke SO, Somassè E, Kabamba B, Luyasu V, Robert A. Scouts, forests, and ticks: Impact of landscapes on human-tick contacts. Ticks Tick Borne Dis 2015; 6:636-44. [PMID: 26055232 DOI: 10.1016/j.ttbdis.2015.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/15/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
Just as with forest workers or people practicing outdoor recreational activities, scouts are at high risk for tick bites and tick-borne infections. The risk of a tick bite is shaped not only by environmental and climatic factors but also by land management. The aim of this study was to assess which environmental conditions favour scout-tick contacts, and thus to better understand how these factors and their interactions influence the two components of risk: hazard (related to vector and host ecology) and exposure of humans to disease vectors. A survey was conducted in the summer of 2009 on the incidence of tick bites in scout camps taking place in southern Belgium. Joint effects of landscape composition and configuration, weather, climate, forest and wildlife management were examined using a multiple gamma regression with a log link. The landscape was characterized by buffers of varying sizes around the camps using a detailed land use map, and accounting for climate and weather variables. Landscape composition and configuration had a significant influence on scout-tick contacts: the risk was high when the camp was surrounded by a low proportion of arable land and situated in a complex and fragmented landscape. The distance to the nearest forest patch, the composition of the forest ecotone as well as weather and climatic factors were all significantly associated with scout-tick contacts. Both hazard- and exposure-related variables significantly contributed to the frequency of scout-tick contact. Our results show that environmental conditions favour scout-tick contacts. For example, we emphasize the impact of accessibility of environments suitable for ticks on the risk of contact. We also highlight the significant effect of both hazard and exposure. Our results are consistent with current knowledge, but further investigations on the effect of forest management, e.g. through its impact on forest structure, on the tick-host-pathogen system, and on humans exposure, is required.
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Affiliation(s)
- Mathilde De Keukeleire
- Earth and Life Institute (ELI), Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium; Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgium.
| | - Sophie O Vanwambeke
- Earth and Life Institute (ELI), Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium
| | - Elysée Somassè
- Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgium
| | - Benoît Kabamba
- Division of Clinical Biology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Bruxelles, Belgium
| | - Victor Luyasu
- Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgium
| | - Annie Robert
- Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgium
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48
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Hofhuis A, Harms M, Bennema S, van den Wijngaard CC, van Pelt W. Physician reported incidence of early and late Lyme borreliosis. Parasit Vectors 2015; 8:161. [PMID: 25889086 PMCID: PMC4363353 DOI: 10.1186/s13071-015-0777-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/03/2015] [Indexed: 11/25/2022] Open
Abstract
Background Lyme borreliosis is the most common vector-borne disease in Europe and North America. The objective of this study is to estimate the incidence of tick bites and Lyme borreliosis, representative of our entire country, including erythema migrans, disseminated Lyme borreliosis and persisting symptoms attributed to Lyme borreliosis. Methods A questionnaire on clinical diagnoses of Lyme borreliosis was sent to all GPs, company physicians, and medical specialists. To adjust for possible misclassification and telescoping bias, we sent additional questionnaires to categorize reported cases according to likelihood of the diagnosis and to exclude cases diagnosed outside the target period. Results Adjusted annual incidence rate for disseminated Lyme borreliosis was 7.7 GP reports per 100,000 inhabitants, and for persisting symptoms attributed to Lyme borreliosis was 5.5 GP reports per 100,000 inhabitants, i.e. approximately 1,300 and 900 cases respectively. GP consultations for tick bites and erythema migrans diagnoses were 495 and 132 per 100,000 inhabitants, respectively, i.e. 82,000 and 22,000 cases in 2010. Conclusions This is the first reported nationwide physician survey on the incidence of tick bites and the whole range of manifestations of Lyme borreliosis, including persisting symptoms attributed to Lyme borreliosis. This is crucial for complete assessment of the public health impact of Lyme borreliosis. Electronic supplementary material The online version of this article (doi:10.1186/s13071-015-0777-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Agnetha Hofhuis
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Margriet Harms
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Sita Bennema
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Cees C van den Wijngaard
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Wilfrid van Pelt
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
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49
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Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- A Mailles
- Foodborne and zoonotic diseases unit, French Institute for Public Health Surveillance, Saint-Maurice, France
| | - V Vaillant
- Foodborne and zoonotic diseases unit, French Institute for Public Health Surveillance, Saint-Maurice, France
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